Guidance issued on reinstating Cquin

The scheme was suspended in 2020/21 and 2021/22, with the NHS in England simplifying payment arrangements due to the need to focus on the pandemic response. But, as outlined in the proposed tariff guidance, it is being re-implemented under the aligned payment and incentives (API) contract being introduced in 2022/23.

Cquin now applies only to contracts within the scope of API, including all relationships between commissioners (clinical commissioning groups or, going forward, integrated care boards) and trusts within an integrated care system; all other commissioner-provider relationships with an expected annual contract value (EACV) of more than £30m; and specialised services commissioned by NHS England.

The value of Cquin for 2022/23 is 1.25% of the fixed element of the API payment. It should be paid in advance in monthly instalments, but commissioners can make deductions, under the variable element of the API approach, for underperformance against the relevant indicators.

Guidance issued by NHS England and NHS Improvement advises contracts have no more than five Cquin indicators – where more than five apply, commissioners and providers should agree and adopt the five most important indicators.

The guidance said the Cquin financial incentive can only be earned on the five most important indicators. The value of each of the indicators should be equally weighted – if there are five indicators, each would be worth 0.25%. Additional local indicators can be agreed if there are fewer than three relevant national indicators for a particular contract.

Where service development is required, providers should be given a realistic expectation of earning a high proportion of the available payment.

There are fewer quality indicators, though they continue to be presented as separate CCG/ICB and specialised services indicators. The 2022/23 guidance sets out 15 CCG/ICB quality indicators and eight indicators for specialised services (17 and nine, respectively, in 2020/21 guidance).

They cover a range of topics, including staff flu vaccination, anaemia screening for patients having major elective surgery, and achieving progress towards Hepatitis C elimination in lead Hepatitis C centres.

An indicator for acute providers focuses on reducing community acquired pneumonia, which is associated with an annual cost of £765m and 29,000 deaths each year. In a recent Getting it Right First Time report, only three trusts reported applying British Thoracic Society guidelines more than 75% of the time. The guidance said implementing the guidance required no additional training or investment, and would reduce 30-day mortality and the length of stay by up to one day, and improve patient experience.

The document added that the indicators support targeted evidence-based improvement rather than ‘complicated and burdensome change’. The design criteria have been retained from previous years and require the indicators:

• Highlight proven, standard operational delivery methods

• Support implementation of relatively simple interventions

• Form part of wider national delivery goals that already exist, thereby not adding new cost pressures

• Are explicitly supported by wider national implementation programmes

• Command stakeholder support.

The guidance stresses the need to report performance against the indicators. Regardless of the local decision on the indicators to be included, API rules require all providers in scope for Cquin to report their performance against all relevant indicators.