West Suffolk Hospital Foundation Trust (WSFT)
Summary of key the features of the 2013/14 Contract
Waiting times
Payments
A&E:
 Did not attends (DNA) are not funded
 15 minutes to initial assessment  Cancellations for non-clinical reasons are not funded
 On average 60 minutes to start
 Most specialties are required to operate within a set ratio of first to follow up outpatients. The
of treatment
Provider cannot simply discharge patients when they meet the ratio
 Single longest wait max 6 hours  Readmissions within 30 days are not funded over 85% (a clinical review will be held in year to
 4 hours to admission or
review pathways)
discharge
 Local tariffs will be agreed in-year for non-Consultant led OP attendances/ clinics that are
Elective patients:
conducting tests/investigations only to agree local prices
 6 weeks for diagnostics
 Patients having had an outpatient first attendance re-attending within 12 months will normally
 18 weeks referral to treatment
be funded as a follow up
Cancer:
 Patients attending A&E and outpatients on the same day will normally only be charged once
 2 weeks to initial assessment
 Maternity activity is now funded based on the patients pathways
 31 days from diagnosis to
 Outpatient imaging has been unbundled from the tariff
treatment
 In-year review of day-case ratios v outpatient procedures to ensure correctly coded-further
 62 days referral to treatment
focus on coding of drug injections (subcutaneous, intramuscular, joints and ophthalmic
Improve average time of
Intravitreal) and infusions
discharge
 A direct access physiotherapy service is running to accept direct referrals from GPs
Cancelled operations should be
 CMS pilot running till end May (£33.00/ plan produced)-evaluated in June
rebooked within 5 days and
 EAU consultants advice and guidance service to continue to support clinical management in
treated within 28 days
the community-this is now part of the core contract.
Discharge Summaries (now monitored by speciality)
General Contract
 A&E and Inpatient discharge summaries should be sent within 24
 Zero tolerance on MRSA
hours of discharge and outpatients in 72 hours
 Max 19 cases c difficile
 Where applicable discharge summaries should contain details of
 All ambulance handovers within 15 mins
the admission and discharge, services provided, details of
 Duty of candour (admitting fault)
diagnosis, details of medication prescribed at discharge, the name  Implementation of WHO Surgical Safety Checklist
of the responsible consultant/key worker, immediate post
 Maintenance of all stroke metrics and caveat in place to
discharge requirements from primary care, follow up
develop dependant on status awarded
arrangements, infection details, a contact name and number,
 Continued focus on reducing pressure ulcers and serious
mental health and LD status, a certificate of sickness, medication
falls to nil for all avoidable
changes and social care discharge information.
Consultant to Consultant (C2C) referrals
Drugs and medications
All C2C referrals accepted unless the patient’s signs
 Inpatients should be discharged with a minimum 14 days medication:
and symptoms are not urgent and are not related to
includes drugs, dressings, supplementary feeds; excludes short course
the originating condition. These patients shall be
steroids/ antibiotics
advised to make an appointment with their GP to
 Outpatients should be discharged with 14 days drugs if the drugs are
discuss any follow-up care that may be required
required in <48 hours (urgent)
(reason/ advise stated on discharge summary)
 Common formulary developed
Patient Transport
Incentive Scheme Improvements over 2012/13:
Eligibility will be
 Psychiatric Liaison (£330k)-development and delivery of a comprehensive Psychiatric Liaison Service
assessed via a central
over two years
assessment service:
 End of life education (£230k)-improving knowledge and skill in staff delivering end of life care.
0845 8500774. Patients
 Nursing e-forms (£201k)-moving towards an e-type patient management system
meeting the medical
 Continuation of 7 day working scheme (£430k)
criteria will have their
 Pain pathway (£115k)- integrated approach to delivering a revised pain pathway and service
transport booked on the
 Breastfeeding (245k)-improved rates of initiation and prevalence through training/ coordination and a
same call. Patients not
home visiting service
meeting the medical
 Stroke (£215k)
criteria will be offered
 Continuation of PAU scheme (£145k)
advice about alternative
 GP expected area (£280k)-ensure patients seen in appropriate area-facility closes at 12 midnight to
means of transport
safeguard use as ward
Low Priority Procedures
 Policies and checklists for partially excluded (PE) and Threshold are available via the link ‘Funding Treatments’ on the front page of
www.suffolk.nhs.uk
 PE procedures should be referred to the Individual Funding Request Panel using the forms on the above link
 If the GP knows a restricted Threshold treatment is being requested, filling out the checklist or giving the same level of information in
a letter is extremely helpful to consultant colleagues
Ipswich Hospital Trust (IHT)
Summary of key features of the 2013/14 contract
Payments
• Did not attends (DNA)
are not funded
• Cancellations for nonclinical reasons are not
funded (e.g. not suitable
for surgery, out of
theatre time,
surgeon/anaesthetist
sick, no beds, equipment
failure)
• Focus on reducing new
to follow-up ratios
• Current live contract
notices for T&O and
Gastro 18 weeks and 15
minute ambulance
handover carried forward
to new contract
• Readmissions
are funded at
72.5%
• Nurse led clinics funded
at 75% tariff
General Contract, Waiting Times and Performance
 The Trust is expected to deliver a maximum wait of::
o 18 weeks from referral to first definitive treatment
o 6 weeks from referral to diagnostic test
o 2 weeks from urgent cancer referral to appointment
o 31 days from cancer diagnosis to first definitive treatment
o 62 days from urgent GP cancer referral to first definitive treatment
o 4 hours from arrival in A&E to discharge, transfer or admission
o 5 days for rebooking a patient following a Trust cancellation of an operation for non-clinical
reasons, The rebooked date is to be within 28 days of the cancellation.
 Ambulance standards: 75% of life threatening or potentially life threatening within 8 minutes; 95% of
same cohort within 19 minutes; 60 to 75% of GP urgent responses within 1 to 4 hours (as requested
by GP)
 Zero tolerance >52 week referral to treatment waits
 Ambulance turnaround 30 minute and 60 minute significant financial consequences
 No patient must wait more than 25 minutes for initial assessment in A&E
 Duty of candour failure to admit fault significant consequences
 Significant consequences on avoidable falls and pressure ulcers
 Breast feeding initiation to 80% by Q4.
 1 hour door to needle for neutropenic sepsis
 National Quality Premium Measures included for unplanned hospitalisation (U19 asthma, diabetes
and epilepsy, chronic ambulatory care sensitive conditions, children with lower respiratory tract
infections, acute conditions that should not usually require hospital admission).
Drugs and
medications
 Inpatients should be
discharged with a
minimum 14 days
medication: includes
drugs, dressings,
supplementary feeds;
excludes short
course steroids/
antibiotics
 Outpatients should
be discharged with
14 days drugs if the
drugs are required in
<48 hours (urgent)
 Common formulary
developed.
Incentive Scheme Improvements
 Outpatient transformation (£800k)
 Expansion of ALL programme with dedicated consultant sessions
 Improvements in % of outpatient letters sent within 5 days
 20% reduction by Q4 in number of patients experiencing changes to their appointments more than 6
weeks from their appointment
 By Q2 95% of clinics must start within 20 minutes of scheduled start time
 7 day diagnostics & Integrated working (£1m)
 Weekend DVT scanning by Q2
 Psychiatric Liaison (£400k)
 Surgical Quality Improvement Benchmarking (£200k)
 International benchmarking of the quality of general surgery outcomes
 80% of diabetes inpatient patients have a specific care plan that they have been involved in by Q2
(£120k)
 By Q4 80% of breast and prostate, 30% of colorectal cancer patients have been risk stratified, have a
holistic plan of care and treatment summary supplied to GP (£200k)
 Increased geriatric consultant liaison with surgical patients (£200k)
 Breast feeding co-ordinator and home visiting model post initiation (£80k)
Low Priority Procedures
Patient Transport
Eligibility will be assessed via a central
 Policies and checklists for partially excluded (PE) and Threshold will be available via
assessment service: 0845 8500774.
the link ‘Funding Treatments’ on the front page of
Patients meeting the medical criteria will
http://www.ipswichandeastsuffolkccg.nhs.uk
have their transport booked on the same
 PE procedures should be referred to the Individual Funding Request Panel using the
call. Patients not meeting the medical
forms on the above link
criteria will be offered advice about
 If the GP knows a restricted Threshold treatment is being requested, filling out the
alternative means of transport
checklist or giving the same level of information in a letter is extremely helpful to
consultant colleagues
Discharge Summaries (now monitored by speciality)
 A&E and Inpatient discharge summaries should be sent within 24 hours of discharge
and outpatients in 72 hours
 Where applicable discharge summaries should contain details of the admission and
discharge, services provided, details of diagnosis, details of medication prescribed at
discharge, the name of the responsible consultant/key worker, immediate post
discharge requirements from primary care, follow up arrangements, infection details, a
contact name and number, mental health and LD status, a certificate of sickness,
medication changes (in a separate box at the top of the letter) and social care
discharge information.
Consultant to Consultant (C2C)
referrals
All C2C referrals accepted unless the
patient’s signs and symptoms are not
urgent and are not related to the
originating condition. These patients
shall be advised to make an appointment
with their GP to discuss any follow-up
care that may be required (reason/
advise stated on discharge summary)
Norfolk and Suffolk Foundation Trust (NSFT): Summary of key features of the 2013/14 contract
Services Available
Waiting times
 Acute Inpatient Adult Mental Health Service
 Median waiting time for specialist cognitive assessment for
dementia to be less than 10 weeks
 Crisis Resolution and Home Treatment Service (CRHT), Older
People Crisis Resolution and Home Treatment Service
 10 day maximum wait from referral to assessment for
Psychological assessment
 Assertive Outreach Service
 10 day maximum wait from referral to treatment for step 2
 Suffolk Early Intervention in Psychosis Service (SEIPS)
Psychological Therapies
 Community Mental Health Teams (CMHT), Older People
 28 day maximum wait from referral to treatment for step 3
Community Mental Health Teams (OPCMHT)
Psychological Therapies

E Ipswich CMHT: 01473 633700
 28 working days from first therapeutic Psychological

W Ipswich CMHT: 01473 296030
Therapies treatment to second treatment session where

Coastal CMHT: 01473 633700
this is required

Bury CMHT: 01284 775250

24 hour maximum wait for urgent referrals and 28 day

Haverhill CMHT: 01440 766060
maximum wait for routine referrals to CMHTs

Newmarket CMHT: 01638 564051
 14 day maximum wait for routine referrals for Early

Sudbury CMHT: 01787 314000
Intervention in Psychosis

Thetford CMHT: 01842 767676

4 hour maximum wait from the time referral is received to
 Adult ADHD Care Pathway
assessment for CRHT
 Rehabilitation service for patients with LT mental health conditions

SEIPS urgent referrals should be responded to in 48
(Chilton Houses, Clozapine clinic, West Suffolk Home Support
hours, routine within 5 working days
Team)
 Adult ADHD patients seen within 28 days of referral
 Services for adults with an eating disorder
 4 days for urgent cases, 28 days for routine Adult Eating
 Dementia: Dementia Intensive Support Team (DIST), Memory
Disorder Service
Assessment Teams (MAT), MH Intermediate Care Team (West)
 The outcome of assessments shall be communicated with
 Integrated Wellbeing Service
the individual (in a way that they shall understand) and the
 Suffolk Alcohol Treatment Service (SATS) (commissioned by
referrer within 3 working days of completion
Suffolk County Council)
 3 weeks for SATS from referral to assessment
 Learning Disability (LD): Assessment and Treatment Service
 18 weeks from referral to treatment for LD A&TS
(A&TS), Community Teams (LDCTs), Step Down and Recovery
 LDCTs: emergencies assessed within 4 hours, urgents in
Service
24 hours and routines within 24 days
 Child and Adolescent Mental Health Service (CAMHS), Connect

15 week maximum wait referral to treatment for Child and
Service, Primary Mental Health Workers (PMHW), Eating
Adolescent Mental Health Services, except:
Disorders, Prison In-reach, Adolescent LD A&TS
 CAMHS PMHWs: first contact in 2 working days,
 Adult autism services will be available from July 2013
appointment within 18 weeks
 Children’s autism services are being reviewed with changes likely in
 Re-referral to teams should be straightforward
October 2013
Service Strategy Changes (formerly radical redesign)
Key Performance Indicators Changes
 NSFT will propose service specifications for the new model based on
 Duty of candour failure to admit fault significant
discussions with CCGs and the public 3 months before
consequences
implementation is due
 Introduction of 20 new cluster related outcome measures
 CCGs will review and where necessary redraft specifications
 Suffolk Wellbeing Service working towards 60% recovery
 Negotiation will be held to agree the final specifications.
rate
CQUIN Incentive Scheme
Discharge Summaries
 Psychiatric Liaison (£696k)
 Inpatient discharge summary – should be sent within 24 hours of
discharge
 CAMHS liaison, education, awareness (£145k)
 All adult patients should have a care plan appropriate to the complexity
 Eating disorders education and awareness (£145k)
 All Learning Disability patients should have a health action plan
 Improving services for people with personality
disorders (£116k)
 All Child and Adolescent Mental Health patients should have a family or
person centred plan
 Maternal mental health education and awareness
(£73k)
 All other patients should have a care plan
 Reducing harm (£73k)
Payments
Patient Transport
This contract remains a block contract this year but the
Eligibility will be assessed via a central assessment service: 0845
Trust and CCGs are working toward implementing
8500774. Patients meeting the medical criteria will have their transport
‘clusters’ of care which will be subject to payment by
booked on the same call. Patients not meeting the medical criteria will
results style pricing (this is a national requirement) from
be offered advice about alternative means of transport
2014/15
Suffolk Community Healthcare (SCH) - managed by Serco
Summary of key the features of the 2013/14 contract
Services Available
Adult

Cardiac Rehabilitation

Leg Ulcer

Bladder and Bowel
Continence

Community Matrons

Early Intervention Team

Falls and Fragility
Fracture Liaison Service

Falls and Osteoporosis
Prevention and
Management Service

Foot and Ankle Surgery

Community Dental

Dermatology (East)
Paediatric
Community
Equipment/
Epilepsy Nursing (West)

Autism
wheelchairs
Minor Injuries Unit (Felixstowe)

Therapy Focus Suffolk

Medical
Podiatry

Community Paediatrics
Appliances
Rapid Response Team

Suffolk Communication

Community
Aid
Resource
Centre
Stoma Care Team
Equipment

Leapfrog
Total Care Team

Wheelchairs

Physiotherapy
Adult Speech and Language Therapy

Occupational Therapy
Heart Failure

Children’s
Integrated discharge planning team
Development Centre
Local Healthcare Teams (including

Community Children’s
community phlebotomy*)
Nursing Team

Community Neurological Service (West)

New Born Hearing

OT – outpatient hand therapy service
Screening
(West)

Parkinson’s (West)
Drugs and medications
Payments

Patients are discharged from inpatient beds with 14 days medication

At the moment this is a block contract
Discharge Summaries
 All patients with long
term conditions should
have been offered a
personal health plan,
take-up is expected to
be 80%
 All inpatients, speech
and language,
admission prevention
and leg ulcer service
discharge summaries
within 1 working day
 All other discharge
summaries to be sent
within 3 working days










Waiting times
 No patient should wait longer than 18 weeks from referral to treatment
 Cardiac rehabilitation: Time till first contact with patient - 3 working days from receipt of referral by single
point of access
 Epilepsy (West): urgent contact within 2 working days, routine within 10 working days
 Falls: All patients referred will be assessed within 2 weeks
 Heart failure: referrals acknowledged within 48 hours, patients seen within 14 days
 Dermatology (east): 8 weeks referral to appointment
 Felixstowe MIU: all patients seen and discharged within 4 hours
 Speech and Language: Priority 1 within 10 days, Priority 2 within 4 weeks, Priority 3 within 18 weeks
 Medical appliance appointments within 6 weeks
 Community neurological service urgent referrals within 2 weeks
 Urgent Parkinson’s referrals contacted within 1 day
 Wheelchair appointments: Priority 1 within 6 weeks, Priority 2 within 12 weeks, Priority 3 within 18 weeks
 Care coordination centre – by January 2014 95% of telephone calls answered within 30 seconds
 Community phlebotomy* patients triaged within 1 working day, urgents seen within 1 working day
Patient Transport
Eligibility will be assessed via a central
assessment service: 0845 8500774. Patients
meeting the medical criteria will have their
transport booked on the same call. Patients not
meeting the medical criteria will be offered
advice about alternative means of transport
Incentive Scheme Improvements (Over 2013/14):
 Reducing hip fractures in the community (£191k)
 Dementia improvements (£191k)
 Reducing harm (£168k)
 Increasing self-management (£144k)
 Improved discharge planning (£115k)
 Recognising and managing the unwell patient (£95k)
 Cancer nurse funding (£29k)
 In depth patient surveys (£24k)
Selected quality requirements
 80% of link GP practices and Community Health Team Leads report 'positive working relationship' with each other. A joint action plan
is expected to be maintained
 95% of people with the following needs that have a named care lead: Palliative care; Chronic leg ulcers; Infected surgical wounds
requiring ongoing dressings; Vulnerable adults
 95% of people with COPD who accept a referral to a pulmonary rehabilitation programme complete the prescribed course and are
discharged within 12 weeks of initial referral by a GP/health professional
 Frontline staff will provide patient’s with brief lifestyle advice, in particular, smoking, weight management and alcohol.
 Referrals to District Nursing should normally be made via the Care Co-ordination Centre (0300 123 2425). Where it is in the patient’s
interest to hold direct conversations with the District Nurse about patient care then this can and should be undertaken in the practice.
*The CCG will be working with SCH to tighten the definition of community phlebotomy services to ensure delivery does not deteriorate.
Cambridge University Hospitals Foundation Trust
(CUHFT)
Summary of key the features of the 2013/14 Contract
Waiting times
A&E:

4 hours to admission or discharge

Unplanned re-attendance rate of below
5%

<5% patients leaving department
without being seen

15 minutes time to initial assessment

On average 60 minutes to start of
treatment
Elective patients:

6 weeks for diagnostics

18 weeks referral to treatment
Cancer:

2 weeks to initial assessment

31 days from diagnosis to treatment

62 days referral to treatment

Cancelled operations should be
rebooked within 5 days and treated
within 28 days
Payments












Did not attends (DNA) are not funded
Cancellations for non-clinical reasons are not funded
Most specialties are required to operate within a set ratio of first to follow up
outpatients. The Provider cannot simply discharge patients when they meet the
ratio
Readmissions within 30 days will not be funded - % applicable will be determined
by a clinical audit
Patients having had an outpatient first attendance re-attending within 12 months
will normally be funded as a follow up
Patients attending A&E and outpatients on the same day will normally only be
charged once
Maternity activity is now funded based on the patients pathways
Outpatient imaging has been unbundled from the tariff
Payment for excess bed-days capped at 12/13 levels
Adjustment to local prices in some areas (eg Echo clinics, rehab and critical care)
have cost neutral impact
Continued roll out of ambulatory care pathways with reduced A&E attendance tariff
Adoption of WSCCG principles for stroke standards
Discharge Summaries (now monitored by speciality)

95% A&E and Inpatient discharge summaries should
be sent within 24 hours of discharge and 100%
outpatients in maximum of 8 days (with no
deterioration for specialties below this level)

Non electronic Summaries will need to state:

Date dictated

Date signed

Date sent

Any procedures carried out

Primary diagnoses
Consultant to Consultant (C2C) referrals

C2C referrals should not be made for unrelated
conditions except where clinical urgency dictates
otherwise.
General Contract

Zero tolerance on MRSA

Max 39 cases c difficile

All ambulance handovers within 15 mins

Duty of candour (admitting fault)

Maintenance of all stroke metrics and caveat in place to develop
dependant on status awarded

Further metrics developed on maternity smoking cessation as a
Local quality premium measure for Cambridgeshire CCGs

Continued focus on reducing avoidable admissions/unplanned
hospitalisation and undertaking clinical pathway reviews
Drugs and medications

The Trust is bound by pack prescribing - Inpatients are
discharged with varying amounts of medication between 7-28
days
Patient Transport
Incentive Scheme Improvements over 2012/13:
Eligibility will be assessed via a
central assessment service:
0845 8500774. Patients
meeting the medical criteria will
have their transport booked on
the same call. Patients not
meeting the medical criteria will
be offered advice about
alternative means of transport







Frail Elderly screening for frailty on admissions (12% of overall CQUIN value)
Frail elderly patients under care of the senior DME team (40%)
Improved communication to carers of patients aged over 85 years (5.6%)
Improvement in % orthopaedic patients aged >65 assessed by Orthogeriatrician within 72
hours (2.4%)
Enhanced discharge summaries for frail elderly patients (5.6%)
Increase in % of patients with heart failure who receive personalised management plan within
30 days of discharge (2.4%)
Specialist DME staff (consultants/nurses to be attached to defined groups of GP practices
(12%)
Low Priority Procedures
The Trust is required to abide by NHS Cambridgeshire’s lower clinical priority policies and surgical threshold policies
(www.cambsphn.nhs.uk/CCPF.aspx)