2014/1513 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B
THE SERVICES
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended December 2013)
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SECTION B PART 1 - SERVICE SPECIFICATIONS
Mandatory headings 1 – 5. Mandatory but detail for local determination and agreement.
Optional heading 6. Optional to use, detail for local determination and agreement.
All subheadings for local determination and agreement.
Service Specification No.
Service
Specialist Fertility Services
Commissioner Lead
Provider Lead
Period
April 2014 – March 2015
Date of Review
1. Purpose
The purpose of Specialist Fertility service is to provide a range of appropriate assisted conception services for
couples who meet the eligibility criteria.
This service specification is an agreement between the East and North Hertfordshire CCG (E&N Herts CCG)
who have commissioned the service on behalf of the 18 Clinical commissioning groups within the East of
England, and the tertiary Providers of specialist fertility services.
1.1 Aims
To provide a quality, safe, cost effective Infertility service ensuring that the risk of infection and other
complications to Service users is minimised.
To provide a personal service sensitive to the physical, psychological and emotional needs of Service users.
To ensure effective communications between Service users and the service providers.
To ensure effective communication between commissioners and the service providers.
To develop and implement a data collection and monitoring processes which provides fertility services
intelligence to support the future commissioning of fertility services across the East of England.
1.2 Evidence Base
(E&N Herts CCG only commission fertility techniques regulated by the Human Fertilisation and Embryology
Authority (HFEA).
This specification is designed to sit alongside the legislative provisions of Infertility treatment and the Care
Standards Act, and is not designed to replicate these provisions, or to duplicate, replicate or supercede the
following policies and guidelines, which may change over time:
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The Human Fertilisation and Embryology Act; 1990
The National Institute for Clinical Excellence Infertility guidance (CG156 - “Fertility: assessment and
treatment for people with fertility problems”); 2013
The East of England Fertility Services Commissioning Guidelines; 2013
National Minimum Standards for Independent Healthcare; 2000
Any Quality standard as determined by the Care Quality Commission
Any Quality standard required under the terms of the Care Standards Act; 2000
Ethnicity
Disability Discrimination Act; 2005
Equality Act 2010
1.3 General Overview
This service provides Specialist Fertility treatment for the East of England Clinical Commissioning Groups that
are a part of the joint consortium.
1.4 Objectives
 To offer Specialist Fertility Services which are safe, effective, appropriate, accessible and acceptable to
Service users, and represent good value for money
 To offer Specialist Fertility treatment in line with the care pathway agreed by East of England Clinical
Commissioning Groups
 To offer Service users consistent, appropriate and suitable information in a format that they can understand.
To offer Specialist Fertility services which are safe, effective, appropriate, accessible and acceptable to Service
users, and represent good value for money.
To offer Specialist Fertility treatment in line with the care pathway agreed by the Clinical Commissioning Groups
(please see appendix 1in the Fertility Services Commissioning Policy).
To offer Service users consistent, appropriate and suitable information in a format that they can understand.
1.5 Expected Outcomes
Improved access to Specialist Fertility services
To be among the top 25% of providers for live birth rates
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Achieve a 40% or higher live birth rate for women aged up to 37 years
Achieve a 20% or higher live birth rate for women aged between 38 years and 40 years
Achieve a 15% or higher live birth rate for women aged between 40 years and 42 years
Reduction in the annual multiple-birth rate to 10% or below
Reduction in the onward transmission of chronic viral infections such as Hep B, Hep C and HIV
2. Service Scope
The East of England residents will receive treatment in line with NICE guidelines, the Department of
Health recommendations the East of England Fertility Services Commissioning guidelines and
individual CCG policies.
2.1 Service Description
The specialist fertility services to be provided to patients fulfilling the eligibility criteria include
 In Vitro Fertilisation (IVF),
 Intra-cytoplasmic Sperm Injection (ICSI)
 Intra Uterine Insemination (IUI- Unstimulated.
 Intra Uterine Insemination (IUI) stimulated- Funded on an exceptional basis, subject to CCG policies.
Surgical sperm retrieval methods including micro-epididymal sperm aspiration (MESA), testicular sperm
extraction (TESE) and percutaneous epididymal sperm aspiration(PESA) and micro TESE. Funded on an
exceptional basis, subject to CCG policies.
 Egg, sperm, embryo and gonadal tissue cryostorage and replacement techniques and other micromanipulation techniques
 Egg donation where no other treatment is available. The patient must be able to provide a donor;
alternatively the patient can be placed on the waiting list until a donor becomes available. This waiting
list will be monitored separately to the general IVF waiting list and will not be subject to an 18-month
maximum waiting time.
 Donor insemination in following conditions obstructive azoospermia, non-obstructive azoospermia,
severe deficits in semen quality in couples who do not wish to undergo ICSI, where there is a high risk of
transmitting a genetic disorder to the offspring, where there is a high risk of transmitting infectious
disease to the offspring or woman from the man
Blood borne viruses (ICSI and sperm washing), as per NICE guidance (section 1.3.9). Do not offer sperm
washing not offered as part of fertility treatment for men with hepatitis B.
The above services are provided in line with NICE clinical guidelines 2013 and HFEA regulations
This service agreement does not cover:
The referral of couples by the secondary Provider to the tertiary Providers, who have not had the
prerequisite investigations or treatments required, at either the primary level or secondary level. The
agreed pro-forma to be used will need to be completed, and will need to include information such as
any investigations, information on patients and clearly state whether the patient is eligible for specialist
treatment.
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2.2 Accessibility/acceptability
The Provider will ensure that, in conjunction with the eligibility criteria set out in section 4.4 – Referral criteria
and sources, its services are accessible regardless of age, disability, race, culture, religious belief, sexual
orientation or income levels. The Provider will deal sensitively with all Service users, potential Service users
and their family/friends and advocates.
2.3 Whole System Relationships
This service specification is an agreement between the East and North Hertfordshire CCG who have
commissioned the service on behalf of the 18 Clinical commissioning groups within the East of England, and the
tertiary Providers of specialist fertility services.
Other parties include the Secondary Care Providers and the Primary Care Providers who will ensure that the
referred couples are compliant with the East of England Specialist Fertility Services Commissioning guidelines.
Clinical Commissioning Groups:
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East and North Herts Clinical Commissioning Group
Basildon and Brentford Clinical Commissioning Group
Bedfordshire Clinical Commissioning Group
Cambridgeshire and Peterborough Clinical Commissioning Group
Castle Point and Rochford Clinical Commissioning Group
Great Yarmouth and Waveney Clinical Commissioning Group
Herts Valley Clinical Commissioning Group
Ipswich and East Suffolk Clinical Commissioning Group
Luton Clinical Commissioning Group
Mid Essex Clinical Commissioning Group
North East Essex Clinical Commissioning Group
North Norfolk Clinical Commissioning Group
Norwich Clinical Commissioning Group
Southend Clinical Commissioning Group
South Norfolk Clinical Commissioning Group
Thurrock Clinical Commissioning Group
West Essex Clinical Commissioning Group
West Norfolk Clinical Commissioning Group
West Suffolk Clinical Commissioning Group
Secondary Providers:
Peterborough & Stamford Hospitals NHS Foundation Trust
James Paget University Hospital NHS Foundation Trust
Norfolk & Norwich University Hospital NHS Foundation Trust
Queen Elizabeth Hospital King’s Lynn NHS Trust
Cambridgeshire University Hospitals Foundation Trust
Hinchingbrooke Health Care NHS Trust
Bedford Hospital NHS Trust
Luton & Dunstable NHS Foundation Trust
Essex Rivers Health Care NHS Trust
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Mid Essex Hospital Services NHS Trust
Princess Alexandra Hospital NHS Trust
Basildon & Thurrock University Hospitals NHS Foundation Trust
Southend University Hospital Foundation Trust
East & North Hertfordshire NHS Trust
West Hertfordshire Hospitals NHS Trust
Ipswich Hospital NHS Trust
West Suffolk Hospitals NHS Trust
2.4 Interdependencies
The Tertiary service Provider will work directly with the following professionals to ensure a seamless service and
the continuity of holistic care:
General Practitioners
General Practitioners with Special Interest
Referring Secondary Provider Clinical Leads and Fertility Nurses
Clinical Commissioning Group Exceptionality Clinical Review Boards
NHS Genetic Services
2.5 Relevant networks and screening programmes
All Providers must be licensed by the Human Fertilisation and Embryology Authority (HFEA). Core skills and
competencies of Staff are set by the HFEA as the regulatory authority for tertiary fertility services.
In addition Providers are expected to comply with relevant legislation, including Health and Safety requirements,
and to follow best practice guidelines.
3. Service Delivery
3.1 Service model
3.1.1 Principles of Care
The Infertility service offered will be safe, effective, appropriate, accessible and acceptable to Service users and
represent good value for money.
Clinical management of eligible couples should be in line with the agreed local care pathway. This is based on
the NICE clinical practice algorithm as modified by individual CCG policies. This local pathway identifies the
tests and treatments to be undertaken within Primary (level 1), Secondary (level 2) and Tertiary care (level 3).
Within the pathway test results should be passed on and not duplicated.
Where clinically appropriate, waiting times should conform to the 18-week pathway, which begins when a
patient is referred from a specialist service to tertiary, and is considered eligible based on the relevant criteria.
Service users should be seen in the chronological order of admission on waiting lists and informed of their
acceptance on the waiting list.
The Provider will co-ordinate Inpatient, day care and outpatient services to ensure continuity of care.
Couples should be seen together because both partners are affected by decisions about investigations and
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treatment and to allow them to participate in planning their care. They should be seen in a comfortable
environment ensuring privacy and dignity.
Couples should be treated by a specialist team to improve the effectiveness and efficiency of treatment and
outcomes. Service arrangements with Tertiary Specialist Providers will be via a specific contract identified by
E&N Herts CCG .
Couples should be provided with consistent, appropriate and suitable information in a format that they can
understand. This information will be provided by the specialist centre.
The Provider will ensure that the Service user is afforded the right to be fully informed of their condition, if they
so wish, and to ensure information is communicated in an understandable and sympathetic manner.
Couples should be offered counselling prior to, during and after assessment or treatment irrespective of the
outcome of that treatment, from someone independent of the treatment team, the cost for which will be met by
the Tertiary Provider.
Couples should be informed that they may find it helpful to contact a fertility support group and information
should be made available on how to access the support group www.infertilitynetworkuk.com
3.1.2 Service Requirements
The Provider will ensure that the Fertility services, where appropriate are shaped around the preferences of
Service users, their families and their carers.
Service users will be treated with respect and their dignity to be safeguarded regardless of age, sex, ethnicity,
religion, culture and sexuality.
Services provided should be culturally sensitive.
Where appropriate, the Provider will work in partnership with other organisations to promote the delivery of a
seamless service.
All staff will respect the confidentiality of the Service user as required by the NHS document: The Care Record
Guarantee (Department of Health, 2007). The Provider will be responsible for asking the patient to sign a
confidentiality release clause to share treatment data to the funding authority.
The Provider will offer the Service user an appropriate and timely first Outpatient Appointment from the initial
referral from the secondary provider.
Hospitalisation will normally be dealt with on a day case basis. If, however, this requires to be extended for
clinical requirements, for a maximum of 24 hours, no further charge will be raised.
If the length of stay is likely to be extended more than 24 hours the Tertiary Provider must contact the on-call
gynaecologist at the nearest District General Hospital to discuss appropriate management. This may require the
Service user to be transferred to an appropriate District General Hospital.
Should emergency re-admission be required within 30 days, as a result of complications arising as a direct
result of the initial clinical operative procedure, this will be absorbed as part of the initial episode of care to a
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maximum of five days.
The Provider will offer a 5 day normal working hours service, with the ability if necessary, to provide services up
to seven days, in addition to an out of hours emergency contact details.
Service users will be offered counselling with a Specialist Fertility Counsellor in line with the HFEA Code of
Practice.
Information sheets in non-technical language should be available to explain the proposed investigations and
treatment, including detailed information on drugs (and any possible side effects) prescribed by the centre.
Information should be tested out with couples to ensure it is user-friendly and available in a range of languages.
Information relating to outcomes should be available for couples on request.
Information to Service users should make it clear that if the treatment centre does not receive contact from the
couple for a six-month period they will be removed from the list.
The Tertiary Provider will confirm the removal from the list by written communication to the named Fertility
Services Contracts Manager at E&N Herts CCG with a copy sent to the Service user, the Service user’s GP
and referring consultant from the secondary provider.
It is the responsibility of the Provider to bear the cost of all ultrasound scans and any additional outpatient
appointments, which may include other tests or observations, until the woman is referred by her GP to the
maternity services.
3.1.3 Treatment Details
For continuity of care delivery, the Service user will have a named Lead Clinician, who will take responsibility for
the Service user during this pathway of care.
Referral criteria and sources are listed in section 4.4 of this document. It is the responsibility of the
commissioned provider to ensure all criteria are met, all relevant investigations are completed, and the specific
number of fresh cycles and embryo transfers allowed to be funded by the referring CCG, has been applied.
Any previous full IVF cycles, whether self- or NHS-funded at any IVF provider including those outside the UK,
will count towards the total number of full cycles that a couple may receive under NHS funding by the individual
CCG.
A full cycle of IVF treatment, with or without intracytoplasmic sperm injection (ICSI), should comprise 1
episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s). This will include
the storage of any frozen embryos for 1 year following egg collection. Patients should be advised at the start
of treatment that this is the level of service available on the NHS and following this period continued storage
mustbe funded by themselves..
An embryo transfer is from egg retrieval to transfer to the uterus. The fresh embryo transfer would constitute
one such transfer and each subsequent transfer to the uterus of frozen embryos would constitute another
transfer.
Before a new fresh cycle of IVF can be initiated any previously healthy frozen embryo(s) must be utilized.
Where couples have previously self-funded a cycle,
then the couples must utilise the previously
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frozen embryos, rather than undergo ovarian stimulation, egg retrieval and fertilisation again.
Embryo transfer strategies:
 For women less than 37 years of age only one embryo or blastocyst to be transferred in the first
cycle of IVF and for subsequent cycles only one embryo/blastocyst to be transferred unless no
top quality embryo/blastocyst available then no more than 2 embryos to be transferred
 For women age 37-39 years only one embryo/blastocyst to be transferred unless no top quality
embryo/blastocyst available then no more than 2 embryos to be transferred.
 For women 40-42 years, double embryo transfer may be considered.
For couples where the woman is under 38 years of age, there should be a six month period between
completion of the pregnancy test post embryo transfer and commencement of drugs for the next fresh cycle.
In the event of abandoned cycle please see Appendix 1.
Should an attempted fresh cycle be abandoned the reason must be recorded in the context of:
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Poor/over ovarian response
Poor fertilisation
Poor embryo quality
Poor Service user compliance
If any fertility treatment results in a live birth, then the couple will no longer be considered childless and will
not be eligible for further NHS funded fertility treatments, including the implantation of any stored embryos.
Any costs relating to the continued storage of the embryos beyond the first calendar year of the retrieval
date, is the responsibility of the couple.
Due to poor clinical evidence, up to 6 cycles of IUI will only be offered under exceptional circumstances and
an application for funding must be made to the CCG. This does not apply to donor sperm which is funded
when clinically indicated.
Treatment will include:
Initial consultation, follow up consultation, and counselling sessions.
All ultrasound scans and hormone assessments during the treatment cycle.
Oocyte recovery - by vaginal ultrasound guided by aspiration under sedation or local anaesthesia or
laparoscopy as appropriate. General anaesthesia will be provided when necessary.
Embryo, or blastocyst transfer, into uterine cavity.
All embryology including sperm preparation and sperm retrieval where indicated.
Embryo/blastocyst freezing and storage will be commissioned as part of the service requirement, and will be
funded for up to 12 months following completion of NHS Treatment, when further discussions with the couple
will need to take place.
A pregnancy test and a maximum of two scans to establish the viability of the pregnancy.
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3.1.4 Drug Prescribing
The commissioned provider of the IVF service under this contract will prescribe and supply the necessary
drugs.
Accurate and detailed information of the drug, the dosage and the frequency and possible side effects will be
given to the Service user including:
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Possible drug interactions
The risk of Ovarian Hyper Stimulation Syndrome (OHSS)
The risks associated with multiple pregnancies
Follow-up and monitoring arrangements, and how the consultant will monitor the woman’s progress
The circumstances under which treatment should be stopped or re-referral made to the secondary provider
consultant
The Tertiary Provider consultant will retain overall clinical responsibility
In accordance with HFEA guidelines, the provider will seek the consent of the Service user to relevant
information being shared with the registered GP.
Subject to the above recommendations being followed, the cost of this prescribing will be part of the contract.
In line with NHS regulations, prescribing costs for residents receiving IVF on a private basis will not be funded
under the NHS.
3.1.5 Service users Reports
The tertiary provider will provide a formal written report to be sent to the referring Clinical Lead from the
secondary provider, with a copy to the Service user and their GP within 5 working days of the first consultation,
out-lining clinical findings, plan of care and waiting list status.
Following the Service user’s first outpatient consultation, a written report will be sent to the Service user’s
referring consultant, copied to the Service user and their GP.
Robust records of treatment given and treatment outcomes and pregnancy outcomes must be recorded against
the woman’s NHS number.
3.1.6 Information & Data Requirements
In order to achieve accurate forecasting, activity monitoring and prompt and accurate payment, there needs to
be timely regular exchange of detailed and accurate information. The Provider will provide the information as
requested, in the format requested and to the agreed timescales. The Provider, in addition to the Information
requirements set out below, will also provide upon request any additional information that the Commissioner
may request.
3.1.7 Standard minimum dataset information
The Provider will be required to submit standard minimum datasets via SUS which comply with guidance
relating to clinical coding published by the NHS Classifications Service and with the definitions of activity
maintained under the NHS Data Model and Dictionary. Timescales for provision of this data will comply with
those specified by SUS and the Standard NHS Contract for Acute Services.
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3.1.8 Activity and financial monitoring information
The Provider will produce activity and financial summaries on a monthly basis which will give an overview of the
performance of the contract for that particular month and for the year-to-date.
3.1.9 Monitoring of performance targets and other outcome measures
The Provider will provide regular monitoring information on a range of performance and outcome measures,
including those outlined in sections 3.1.12 and 3.1.13.
The Provider will also provide regular status reports on each couple referred for treatment, which will include
details of the treatments-to-date.
3.1.10 Information Governance
The provider shall conform to the Data Protection Act, (Department of Health, 2006)
3.1.11 Quality of Information
The Provider will ensure that all data provided is complete, accurate and timely.
The Provider will ensure that it’s staff do not adopt, desist from any current clinical protocol, practice or
procedure, or any administrative (or coding) practice or procedure, which will either intentionally or
inadvertently, maximise income to the Provider, rather than to reflect the actual necessary treatment received
by a Service user, or a group of Service users.
3.1.12 Performance Targets
The Provider will comply with current performance targets as laid down by the Department of Health and any
local additional performance targets defined by the East of England.
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18 week pathway for Fertility services (2008)
It will be the responsibility of the Provider to identify, in a timely fashion in advance of the occurrence,
any Service user where the performance targets and maximum waiting times as identified within the this
document cannot be met by the Provider. The provider will then agree with the Lead Commissioner from the
E&N Herts CCG , the necessary actions to remedy these breaches of the service management.
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All tertiary providers will have an elective Single Embryo Transfer (eSET) Strategy, inclusive of selection
criteria, for implementation from April 2009 as per HFEA requirements, to reduce multiple births to 10% by
2011.
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A 40% or higher live birth rate for women aged up to 37 years
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A 20% or higher live birth rate for women aged between 38 years and 40yrs
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A 10% or higher live birth rate for women 40 years to 42 years
3.1.13 Outcomes
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Regular meetings will be held to review the service and improve on any aspects of the service as required (not
less than every six months)
3.1.14 Service user Satisfaction
Using the HFEA Service user questionnaire, the Provider will give regular feedback to the
E&N Herts CCG , on the recommendations and action plans of these audits.
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3.1.15 Complaints
The Provider must establish a written complaints procedure. The procedure must incorporate the following:
 A nominated person within the organisation to be responsible for handling complaints;
 Complaints must be acknowledged within 2 working days;
 A full response or holding letter, signed by the Chief Executive or equivalent, to be sent within 20 working
days;
 The E&N Herts CCG may wish to conduct an Independent Review Panel Investigation if they are
dissatisfied with the Provider's response.
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3.1.16 Waiting times for Tertiary Service Provision There will be no user waiting over 18 weeks from
referral to the commencement of treatment unless there are mitigating medical circumstances
The service will work towards reducing waiting times below these levels to achieve and improve upon the
national standards.
3.1.17 Clock Stops as per the Department of Health 2008 18 week pathway for fertility services i.e. when
the procedure starts
 Gonadotrophin stimulation of hypogonadal men
 Treatment for pituitary tumours and other medical conditions discovered
 For IUI, IVF, ICSI, PGD as above if cycle control issues take time or if the Service user is not ready the clock
can be stopped. The clock stop is the first day of the menstrual cycle in which the assisted conception is to
start.
 Service users waiting for egg/sperm donation: the clock stops once they are put on the waiting list (as per
transplant lists)
 Post surgery in the event of a miscarriage/ectopic pregnancy
 Ovarian Hyperstimulation Syndrome (OHSS)
 Active monitoring will begin once the Service user is on a recognised local protocol.
3.1.18 Outcome Data
Information on the Provider’s activities will be provided on a quarterly basis, submitted by week 5 of the
quarterly end, as follows:
Basic outcome data
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Number of couples seen
Number of couples treated
Implantation rates per embryo transfer (IVF)
Implantation rates per cycle of per blastocyst transfer
Live birth rates per embryo transfer treatment cycle
Clinical pregnancy rate – singleton and multiple
Implantation rates and live birth rates by:
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Age bands 23-24, 25-29, 30-35,36-39, 40-42
Diagnostic group
GP and Postcode
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Complications
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Twin clinical pregnancy rate.
Twin births per treatment cycle.
Ectopic pregnancies per treatment cycle.
Rate of Ovarian Hyper-stimulation Syndrome (OHSS) – severity and duration of hospitalisation
Other adverse outcomes needing inpatient management
3.1.19 Facilities and Equipment
The provider will be required to show evidence that all equipment used is regularly maintained to a standard
commensurate with the needs of the service.
3.1.20 Service Agreement Management
The provider and the lead commissioner will nominate a contract manager who will be responsible for the
operation of the service agreement. This contract manager is to be available to the lead commissioner, or the
provider, during normal working hours.
Where due to sickness, absences or annual leave the contract manager is unavailable, then the lead
commissioner and the provider will identify a suitable replacement officer who will be able to provide assistance
to the other party in any enquiry regarding this service agreement, or its operations.
3.2 Care Pathways
The Care pathway route is detailed in Appendix 2. Referrals that do not adhere to this pathway should not be
accepted and returned to the originating referrer.
4. Referral, Access and Acceptance Criteria
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4.1 Geographic coverage/boundaries
The Provider will provide assisted conception services for couples who are registered with a member GP
practice of the relevant CCG, and who have been referred by named GPSI’s and Consultant Gynaecologists.
Referrals from NHS Trusts outside of the East of England will be accepted provided that the couples are
registered with a member GP practice of the relevant CCG, meet the eligibility criteria set out within this
specification, and the appropriate diagnostics have been completed.
4.2 Location(s) of Service Delivery
[Insert details] To be agreed with Provider(s)
4.3 Days/Hours of operation
As Required
4.4 Referral criteria & sources
Referrals for Infertility treatment must be from the following pathways;
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Referral from GP (Primary Care) following primary investigations to secondary provider services.
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Referral from the Secondary Provider service named Gynaecologist or GPSI, following on from a diagnosis
of infertility. Secondary investigations and/or treatments to have been undertaken (see Criterion number 14
– minimum investigations)
Self referrals or from any other source than those detailed above will not be accepted and the Service user
should be directed back to their GP.
Couples will be assessed for referral using the following referral criteria as per the relevant CCG Policy. The
following information must be checked against the relevant policy:
Criterion
1
Ovarian Reserve Testing, use one of
the following:
 FSH
Description
To be eligible, the patient should have an FSH within
3 months of referral and day 2 of the menstrual cycle
of <8.9IU/L
2
Women aged 23 to 39 years at the start of superovulation (treatment) but where a woman reaches
the age of 40 during treatment they will complete
that cycle in the 40th year and will not be entitled to
commence further cycles.
Maternal age
Women aged between 40-42 may be entitled to 1
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3
Paternal Age
4
Minimum / Maximum BMI
5
Duration of sub-fertility
6
Previous Fertility treatment:
A. Women <40 years
cycle of IVF but where:
 They have never previously had IVF
treatment
 There is no evidence of low ovarian reserve
 There has been a discussion of the additional
implications of IVF and pregnancy at this
stage
(see appendix in Fertility Policy Document for
relevant CCG criteria and funding levels)
Any treatment cycle must be commenced before the
male is 55 years of age.
Between at least 19 and up to 30. Patients outside
of this range will not be added to the waiting list and
should be referred back to their referring clinician
and/or general practitioner for management if
required.
Unexplained infertility for 3 years or more of regular
intercourse or an equivalent 12 cycles of artificial
insemination over a period of 3 years. There is no
criterion for cases with a diagnosed cause of
infertility. See also criteria no 13.
NHS treatment limit will be determined by local CCG
policy up to maximum of 6 embryo transfers,
including a maximum of 3 fresh cycles of IVF, or
IVF with ICSI)
All frozen embryos should be used before a new
fresh cycle is funded.
Previous privately funded cycles will count towards
the total number of cycles funded by the NHS
7
Women ≥40 years
NHS treatment limit will be determined by local CCG
policy up to maximum of 2 embryo transfers,
including a maximum of 1 fresh cycle of IVF, or IVF
with ICSI.
All frozen embryos should be used before a new
fresh cycle is funded.
Previous privately funded cycles will count towards
the total number of cycles funded by the NHS
Couples who smoke will not be eligible for NHSfunded specialist assisted reproduction assessment
or treatment
8
Smoking Status
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9
Parental Status
10 Previous sterilisation
11 Child Welfare
12 Medical Conditions
13 Residential Status
14 The cause of Infertility
15 The minimum investigations required
prior to referral to the Tertiary centre
are:
Where either of a couple smokes, only couples who
agree to take part in a supportive and successful
programme of smoking cessation with Carbon
Monoxide verification as an evidence of non
smoking status. Will be accepted onto the IVF
treatment waiting list.
Couples are ineligible for treatment if there are any
living children from the current or any previous
relationships, regardless of whether the child resides
with them. This includes any adopted child within
their current or previous relationships; this will apply
to adoptions either in or out of the current or
previous relationships.
Ineligible if previous sterilisation has taken place
(either partner), even if it has been reversed.
Providers must meet the statutory requirements to
ensure the welfare of the child. This includes
HFEA’s Code of Practice which considers the
‘welfare of the child which may be born’ and takes
into account the importance of a stable and
supportive environment for children as well as the
pre-existing health status of the parents.
Treatment may be denied on other medical grounds
not explicitly covered in this document.
All Service users must be registered with a member
Primary Care Practice of the relevant CCG for a
minimum of 12 months.
In order to be eligible for treatment, Service users
should have experienced unexplained infertility for
three years or more of regular intercourse or 12
cycles of artificial insemination over a period of 3
years. There is no criterion for couples with a
diagnosed cause of infertility – see below:
(a) Tubal damage, which includes:
 Bilateral salpingectomy
 Moderate or severe distortion not amenable
to tubal surgery
(b) Premature Menopause
(c) Male factor infertility
(d) Ovulation problems adequately treated but not
successfully treated i.e no successful pregnancy
achieved
(e) Endometriosis where Specialist opinion is that
IVF is the correct treatment
(f) Cancer treatment causing infertility necessitating
IVF/ICSI (eligibility criteria still apply)
Female:
 Laparoscopy and/or hysteroscopy and/or
hysterosalpingogram or ultrasound scan where
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



16 Pre-implantation Genetic Diagnosis
17 Rubella Status
18 Virology Status
appropriate
Rubella antibodies
Day 2 FSH, LH and Estradiol
Chlamydia screening
Hep B and Hep C and HIV status
Male:
 Preliminary Semen Analysis and appropriate
investigations where abnormal (including
genetics)
 Hep B and Hep C (should have been checked
within the last 2 years)
 HIV status
PGD and associated specialist fertility treatment is
the commissioning responsibility of NHS England
and is excluded from the CCG commissioned
service.
The woman must be rubella immune
Where one partner or both has a positive diagnosis
of HIV, Hepatitis B or Hepatitis C, referral should be
made through the Consortium which has already
placed a contract for these couples.
4.5 Referral route
The Provider must ensure that the correct referral route is followed. This is set out within section 3.2 Care
pathways.
The referral must be within the scope of the Fertility services 18 week pathway as per the Department of Health
2008 – www.18weeks.nhs.uk.
4.6 Exclusion criteria
Treatment will not be offered to Service users where the referral has been initiated from a non-approved source
or where the couple do not meet the referral criteria as set out in section 4.4 – Referral Criteria and Sources.
4.7 Response time & detail and prioritisation
The referral letter from Secondary Provider to tertiary provider must be responded to within 5 working days with


An acknowledgement to the GP
A first outpatient appointment (OPD) sent to the Service user
Treatment will commence as soon as possible, determined by the woman’s menstrual cycle.
5. Transfer of and Discharge from Care Obligations
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Discharge from the Tertiary Provider service will occur before the completion of a maximum of 6 embryo
transfers or a maximum of 3 fresh cycles when either:



A live baby has been born
The couple choose not to proceed
There is clinical evidence to show that a successful outcome will not be possible
Written confirmation will be sent to the referring consultant and/or GP with a copy to the Service user detailing
the reasons for the above action.
Should there be an unsuccessful treatment outcome; specialist fertility counselling will be offered at the expense
of the Tertiary Provider.
Should the couple have a viable pregnancy and are requiring access to maternity services the following should
occur:
 A letter confirming the pregnancy will be forwarded to the GP and referring consultant
 The GP will refer the pregnant woman to the maternity services at or around 8 weeks of pregnancy
 The woman should access the midwifery services between 8-10weeks
6. Self-Care and Service user / Carer Information
The Provider shall provide information, advice and support for self-care as set out in Section 3.1 - Service
model.
7. Quality Requirements
Performance
Indicator
Indicator
Threshold
Method of
Measurement
Frequency
Monitoring
Service user
Experience
HFEA Service user
questionnaire
Performance
Management report
As per agreed
Schedule
Service users
Experience
Improvement Plan
Outcomes
Local Action Plan to be
agreed
Greater 80%
completed
surveys
100%
Performance
Management report
As per agreed
Schedule
40% or higher live birth
rate for women aged up
to 37 years
100%
Performance
Management report
As per agreed
Schedule
20% or higher live birth
rate for women aged
between 38 and 40 years
100%
10% or higher live birth
rate for women aged
between 40 and 42 years
100%
Quality
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Performance
Management report
Performance
Management report
As per agreed
Schedule
As per agreed
Schedule
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Elective Single
Embryo Transfer
(eSET) Strategy
Reduce total number of
multiple births to 10% in
line with HFEA
requirements
100%
Performance
Management report
As per agreed
Schedule
Service user
Information
All Service user
information to be
referenced by the User’s
NHS number and GP
100%
Performance
Management report
As per agreed
Schedule
Decided locally
Performance
Management report
As per agreed
Schedule
100%
Performance
Management report
As per agreed
Schedule
Performance & Productivity
Access
Complaints
Local Plan to ensure
equality of access to
Service Provider’s
services.
Complaints to be
acknowledged within 2
working days of complaint
receipt
A full response or holding
letter, signed by the Chief
Executive of the Provider
to be sent within 20
working days
100%
Performance
Management report
As per agreed
Schedule
Waiting Times
Service user
Information
Counselling
No Service user will wait
over 18 weeks from
referral to
commencement of
treatment unless there
are mitigating medical
circumstances
A formal report to be sent
to the referring Clinical
lead from the Secondary
Provider, with a copy to
the Service user and their
GP within 5 working days
of the First consultation
outlining:
 Clinical findings
 Plan of Care
 Waiting List status
All Service users will be
offered access to a
Specialist Counsellor in
line with HFEA Code of
Practice
Performance
Management report
100%
As per agreed
Schedule
100%
Performance
Management report
As per agreed
Schedule
100%
Performance
Management report
As per agreed
Schedule
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
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8. Activity
8.1
Activity Performance Indicators
Threshold
Submission of Contract Minimum
Dataset to SUS
Number of Service users treated
within the 18 week pathway
Number of Service users seen for
First Outpatient Attendance within 6
weeks
Number of Service users who have
commenced first cycle treatment
within 6 weeks of First Outpatient
attendance
Total number of Couples seen
100%
100%
100%
100%
Implantation rates per embryo
transfer (IVF) by






Quarterly Monitoring
report
Total Number
By year age band (24-25, 26-29,
30-35, 36-39, 40-42
GP
Postcode
Live Birth rates per embryo transfer
treatment cycle by


Quarterly
monitoring report
Total Number
By year age band (24-25, 26-29,
30-35, 36-39, 40-42
GP
Postcode
Implantation rates per cycle of
blastocyst transfer by


Consequence
breach
Quarterly
monitoring report
Quarterly
monitoring report
Quarterly
monitoring report
Total number of Couples treated


Method of
measurement
Activity monitoring
report
Quarterly
monitoring report
Quarterly
monitoring report
Total Number
By year age band (24-25, 26-29,
30-35, 36-39, 40-42
GP
Postcode
40% or higher live
birth rate for women
aged up to 37 years
Quarterly Monitoring
report
20% or higher live
birth rate for women
aged between 38
and 40 years
10% or higher live
birth rate for women
aged between 40
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and 42 years
Clinical pregnancy rate – singleton
and multiple




Quarterly monitoring
report
Total Number
By 5 year age band (20-24, 25-29
etc)
GP
Postcode
Twin clinical pregnancy rate by Age
group
Twin Births per treatment cycle by
Age group
Ectopic pregnancies per treatment
cycle
Rate of Ovarian Hyper-stimulation
Syndrome (OHSS) – severity and
duration of hospitalisation
Total no of Other Adverse outcomes
needing inpatient management of
>24 hours
Total Number of Re-Admissions
within 30 days of the initial Clinical
operative procedures as a result of
Other Adverse outcomes
<= 10%
<=10%
Quarterly Monitoring
report
Quarterly Monitoring
report
Quarterly Monitoring
report
Quarterly Monitoring
report
Quarterly monitoring
report
Quarterly monitoring
report
8.2 Activity Plan
9. Prices & Costs
1) IVF
Standard package will include:
Initial consultation, follow up consultation, and counselling sessions.
All ultrasound scans and hormone assessments during the treatment cycle.
Oocyte stimulation
Oocyte recovery - by vaginal ultrasound guided by aspiration under sedation or local anaesthesia or
laparoscopy as appropriate. General anaesthesia will be provided when necessary.
IVF or ICSI to produce embryos and blastocyst culture as appropriate.
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Embryo, or blastocyst transfer, into uterine cavity.
Embryo/blastocyst freezing and storage will be commissioned as part of the service requirement, and will be
funded for up to 12 months following completion of NHS Treatment, when further discussions with the couple
will need to take place.
A pregnancy test and a maximum of two scans to establish the viability of the pregnancy.
Drug costs
2) Surgical sperm recovery where indicated (TESA/PESA)
[Insert details]
3) Frozen embryo transfer
[Insert details]
4) IUI
[Insert details]
5) Donor oocyte cycle
[Insert details]
6) Refunds for abandoned cycles
[Insert details]
Where appropriate all packages will include first and follow up consultation and counselling:



Scans and hormone assessments
Pregnancy tests and pregnancy scan for viability
Any drug costs
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AND LEARNING DISABILITY SERVICES
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APPENDIX 1
Action in the event of an IVF/ICSI treatment cycle not reaching embryo transfer
A “non-abandoned” cycle of IVF/ICSI is one where one or more embryos resulting
from treatment are transferred to the uterus. An “abandoned” cycle is one which does
not reach the stage of embryo transfer.
If a cycle is abandoned further action should depended on the clinical circumstances
and the reason for abandoning the cycle. If the cycle was abandoned due to
predictable, non-correctable factor, further treatment should NOT be offered as it has
a low likelihood of success. Where there is a non-predictable or correctable cause,
further attempts should be made to achieve a completed cycle of treatment.
1. Cycle cancelled owing to poor ovarian response on maximal gonadotrophin
stimulation (ie 450 iu FSH daily): No further treatment, as high likelihood of failure in
subsequent cycles.
2. Cycle cancelled due to poor ovarian response on less than maximal
gonadotrophin stimulation: Further attempts using maximal stimulation, provided
repeat Day 2 FSH is within the criteria (<8.9 iu/l)
3. Cycle cancelled due to excessive ovarian response and no eggs retrieved:
Further attempts with lower dose of gonadotrophin
4. Cycle cancelled due to excessive ovarian response, embryos created: Frozen
embryo transfer.
5. Cycle cancelled due to failure of fertilisation at standard IVF: Further attempts
using ICSI
6. Cycle cancelled due to failure of fertilisation using ICSI: No further treatment.
7. Cycle cancelled due to incident clinical factor coming to light during treatment (e.g.
hydrosalpinx or endometrioma): Further attempts after correcting the abnormality.
8. “Exceptional” reasons (e.g. death in family): individualise on a case by case basis.
Categories of abandoned cycles: Abandoned cycles fall into three categories.
1. Abandoned cycles before attempted egg retrieval:
2. Abandoned cycles after unsuccessful egg retrieval attempt:
3. Abandoned cycles after successful egg retrieval (+/-embryo creation)
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
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2014/15 NHS STANDARD CONTRACT
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2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
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2014/15 NHS STANDARD CONTRACT
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AND LEARNING DISABILITY SERVICES
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SECTION B PART 2 - ESSENTIAL SERVICES
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
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2014/1513 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 3 - INDICATIVE ACTIVITY PLAN
BOURN HALL CLINIC 12/11 Proposal
Data
Month
Plan and Price list 11/12 and 12/13
Estimte
based on
M9/*12
Sum of Activity Actual YTD
HRG Description
Abandoned Treatment
Cycles
Counselling Sessions
Donor Oocytes
Donor Sperm Per Treatment
Donor Sperm Family Slot
Electro Ejaculation
Embryo Storage
FET
First outpatient attendance
Followup Outpatient
appointments
ICSI
IUI Intrauterine insemination
IVF
Surgical Sperm Retrieval
Grand Total
1
2
3
4
5
6
7
8
26
5
4
39
1
19
6
1
50
4
29
7
1
65
6
35
9
37
36
85
75
134
121
195
155
1
78
7
40
11
1
274
181
1
117
12
45
14
1
332
203
1
117
12
54
16
1
395
236
5
153
15
63
17
2
503
270
41
135
77
4
63
123
276
160
9
132
428
Total Value
11/12
Total Value
12/13
Abandoned Treatment Cycles
Counselling Sessions
9 Total
5
211
15
70
17
2
548
317
7
281
20
93
23
3
731
423
£
£
£
£
£
£
£
£
10,000
16,880
55,000
46,667
22,667
8,000
73,067
338,133
£
£
£
£
£
£
£
£
9,820
16,576
54,010
45,827
22,259
7,856
71,751
332,047
234 302 350 401 482 588 669
430 521 616 721 818 899 1,051
250 327 427 510 589 679 740
14
16
20
21
22
22
26
198 259 334 390 464 522 566
3
6
10
13
15
17
17
925 1,475 1,897 2,350 2,781 3,222 3,755 4,254
892
1,401
987
35
755
23
5,672
£
£
£
£
£
£
£
129,340
106,501
3,305,333
15,600
2,226,267
34,000
6,387,455
£
£
£
£
£
£
£
127,012
104,584
3,245,837
15,319
2,186,194
33,388
6,272,480
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended December 2013)
GATEWAY REFERENCE: 16953
Specialty
Plan
Activity Plan Cost
11/12
11/12
Donor Embryos
Donor Oocytes
donor Sperm Per Treatment
Donor Sperm Family Slot
Electro Ejaculation
Embryo Storage
FET
First outpatient attendance
Followup Outpatient appointments
ICSI
IUI Intrauterine insemination
IVF
Surgical Sperm Retrieval
Total
50
220
1
18
70
35
0
650
310
11/12
Price
£75,000 £ 1,500
£13,200
£1,500
£49,500
£35,000
£35,000
£0
£65,000
£248,000
12/13
Price List
27 £
1,473
60
1,500
2,750
500
1,000
3,000
100
800
1.08
27
49.5
9
18
54
1.8
14.4
£
£
£
£
£
£
£
£
59
1,473
2,701
491
982
2,946
98
786
990
£143,550 £
145
1200
£91,200 £
76
910 £3,048,500 £ 3,350
40
£18,000 £
450
719 £2,121,050 £ 2,950
37
55500 £ 1,500
2.61
1.368
60.3
8.1
53.1
27
£
£
£
£
£
£
142
75
3,290
442
2,897
1,473
5250 £6,000,000
£
£
£
£
£
£
£
£
Less
1.8%
2014/1513 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 4 – ACTIVITY PLANNING ASSUMPTIONS
[Insert/append Activity Planning Assumptions]
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended December 2013)
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AND LEARNING DISABILITY SERVICES
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SECTION B PART 5 – ACTIVITY MANAGEMENT PLAN
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
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SECTION B PART 6 - NON-TARIFF AND VARIATIONS TO TARIFF PRICES
Section B Part 6.1:
Non-Tariff Prices
As Per Finance Section B Part 7
Section B Part 6.2:
NOT APPLICABLE
Variations to Tariff Prices
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
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AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 7 - EXPECTED ANNUAL CONTRACT VALUES
BOURN HALL CLINIC 12/11 Proposal
Data
Month
Plan and Price list 11/12 and 12/13
Estimte
based on
M9/*12
Sum of Activity Actual YTD
HRG Description
Abandoned Treatment
Cycles
Counselling Sessions
Donor Oocytes
Donor Sperm Per Treatment
Donor Sperm Family Slot
Electro Ejaculation
Embryo Storage
FET
First outpatient attendance
Followup Outpatient
appointments
ICSI
IUI Intrauterine insemination
IVF
Surgical Sperm Retrieval
Grand Total
1
2
3
4
5
6
7
8
26
5
4
39
1
19
6
1
50
4
29
7
1
65
6
35
9
37
36
85
75
134
121
195
155
1
78
7
40
11
1
274
181
1
117
12
45
14
1
332
203
1
117
12
54
16
1
395
236
5
153
15
63
17
2
503
270
41
135
77
4
63
123
276
160
9
132
428
Total Value
11/12
Total Value
12/13
Abandoned Treatment Cycles
Counselling Sessions
9 Total
5
211
15
70
17
2
548
317
7
281
20
93
23
3
731
423
£
£
£
£
£
£
£
£
10,000
16,880
55,000
46,667
22,667
8,000
73,067
338,133
£
£
£
£
£
£
£
£
9,820
16,576
54,010
45,827
22,259
7,856
71,751
332,047
234 302 350 401 482 588 669
430 521 616 721 818 899 1,051
250 327 427 510 589 679 740
14
16
20
21
22
22
26
198 259 334 390 464 522 566
3
6
10
13
15
17
17
925 1,475 1,897 2,350 2,781 3,222 3,755 4,254
892
1,401
987
35
755
23
5,672
£
£
£
£
£
£
£
129,340
106,501
3,305,333
15,600
2,226,267
34,000
6,387,455
£
£
£
£
£
£
£
127,012
104,584
3,245,837
15,319
2,186,194
33,388
6,272,480
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended December 2013)
GATEWAY REFERENCE: 16953
Specialty
Plan
Activity Plan Cost
11/12
11/12
Donor Embryos
Donor Oocytes
donor Sperm Per Treatment
Donor Sperm Family Slot
Electro Ejaculation
Embryo Storage
FET
First outpatient attendance
Followup Outpatient appointments
ICSI
IUI Intrauterine insemination
IVF
Surgical Sperm Retrieval
Total
50
220
1
18
70
35
0
650
310
11/12
Price
£75,000 £ 1,500
£13,200
£1,500
£49,500
£35,000
£35,000
£0
£65,000
£248,000
12/13
Price List
27 £
1,473
60
1,500
2,750
500
1,000
3,000
100
800
1.08
27
49.5
9
18
54
1.8
14.4
£
£
£
£
£
£
£
£
59
1,473
2,701
491
982
2,946
98
786
990
£143,550 £
145
1200
£91,200 £
76
910 £3,048,500 £ 3,350
40
£18,000 £
450
719 £2,121,050 £ 2,950
37
55500 £ 1,500
2.61
1.368
60.3
8.1
53.1
27
£
£
£
£
£
£
142
75
3,290
442
2,897
1,473
5250 £6,000,000
£
£
£
£
£
£
£
£
Less
1.8%
2014/1513 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 8 - QUALITY
Section B Part 8.1:
Quality Requirements
NOT APPLICABLE
Technical
Guidance
Reference
PHQ10
Quality Requirement
Threshold
Method of
Measurement
Consequence of
breach
The number of new
cases of psychosis
served by early
intervention teams year
to date
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PHQ11
Percentage of inpatient
admissions that have
been gatekept by crisis
resolution/ home
treatment team
95%
[Insert as per
local
determination]
[Insert as per
local
determination]
PHQ12
The proportion of
people under adult
mental illness
specialties on CPA who
were followed up within
7 days of discharge
from psychiatric inpatient care during the
quarter
95%
[Insert as per
local
determination]
[Insert as per
local
determination]
PHQ13
Access to psychological
therapies should be
improved
 The proportion of
people who have
completed
treatment having
attended at least 2
treatment contacts
and are moving to
recovery
Rate of recovery
for each service
in each quarter of
2012/13 should
be higher than
previous quarter
until 50%
recovery rate is
achieved and
when achieved
maintained
[Insert as per
local
determination]
[Insert as per
local
determination]
People with learning
disabilities and/or
autistic spectrum
conditions (ASC) should
be able to access
mainstream services
when necessary
 Reasonable
adjustments are
made to services to
allow access to
mainstream mental
health and other
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended December 2013)
GATEWAY REFERENCE: 16953
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Technical
Guidance
Reference
PHQ27
Quality Requirement
services as
necessary
Meticillin resistant
Staphylococcus Aureus
(MRSA) bacteraemia
Threshold
Method of
Measurement
Consequence of
breach
[Insert the
Provider’s
centrally set
trajectory for the
reduction in the
incidences of
MRSA ]
[Insert as per
local
determination]
[Insert as per
local
determination]
PHS17
Number of health
visitors
[If applicable to
the Services,
insert SHA
agreed threshold]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_01
Ambulance call
abandonment rate
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_02
Ambulance re-contact
rate following discharge
of care
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_03
Ambulance outcome
from cardiac arrest –
return of spontaneous
circulation
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_04
Ambulance service
experience
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_05
Ambulance outcome
from acute ST-elevation
myocardialinfarction
(STEMI)
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_06
Outcome from stroke for
ambulance patients
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_07
Ambulance outcome
cardiac arrest - survival
to discharge
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_08
Ambulance time to
answer call
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
PSQ02_09
Ambulance
time
to
treatment for Cat A calls
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]

median time of
arrival

95th percentile
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B1
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Technical
Guidance
Reference
Quality Requirement

PSQ02_10
Threshold
Method of
Measurement
Consequence of
breach
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
99th percentile
Ambulance calls closed
with telephone advice or
managed without
transport to A&E (where
clinically appropriate)
A&E indicators (1):
The Provider shall
satisfy at least one of
the following Patient
Impact Indicators, and
at least one of the
following Timeliness
Indicators:
Patient Impact
Indicators:
1. Unplanned reattendance rate
Patient Impact
Indicators:
1. A rate above
5%
2. Left department
without being seen
[rate]
2. A rate at or
above 5 %
Timeliness Indicators:
Timeliness
Indicators:
1. 95% of patients
waiting less than
4 hours for
admitted patients
and with the
same threshold
for non-admitted
1. Total time spent in
A&E department
2. Time to initial
assessment (95th
percentile)
2. A 95th
percentile time to
assessment
above 15 minutes
3. Time to treatment in
department (median)
3. A median time
to treatment
above 60 minutes
A & E indicators (2):
1. percentage of A& E
attendances for cellulitis
and DVT that end in
admission
1. [Insert as per
local
determination]
2. number of
2. [Insert as per
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B2
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Technical
Guidance
Reference
Quality Requirement
Threshold
Method of
Measurement
Consequence of
breach
admissions for cellulitis
and DVT per head of
weighted population
local
determination]
3. percentage of
Patients presenting at
type 1 and 2 (major)
A & E sites in certain
high risk categories who
are reviewed by an
emergency medicine
consultant before being
discharged
3. [Insert as per
local
determination]
4. A & E service
experience
4. [Insert as per
local
determination]
Provider cancellation of
Elective Care operation
for non-clinical reasons
either before or after
Patient admission
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
Provider failure to
ensure that “sufficient
appointment slots” are
made available on the
Choose and Book
system
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
Breach of Clause 40.5
of the Core Legal
Clauses (cancelled
operations)
[Insert as per
local
determination]
[Insert as per
local
determination]
Provider must pay
for the relevant
Patient’s
treatment by
another provider
of the Patient’s
choice
Delayed transfers of
care to be maintained at
a minimal level
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
Percentage of SUS data
altered in period
between (a) 5
Operational Days after
month-end, and (b) the
Inclusion Point for the
month in question
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
Satisfaction of the
Provider’s obligations
under each Ambulance
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B3
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Technical
Guidance
Reference
Quality Requirement
Threshold
Method of
Measurement
Consequence of
breach
Failure to agree the
EMSA Plan in
accordance with Clause
30.2 of the Core Legal
Clauses
[Insert as per
local
determination]
[Insert as per
local
determination]
Withholding of up
to 1% of all
monthly sums
payable under
Clause 7 (Prices
and Payments) of
the Core Legal
Clauses for each
month, or part
month, that the
breach continues
Breach of an EMSA
Plan milestone
[Insert as per
local
determination]
[Insert as per
local
determination]
Agreed
consequence or
retention of
agreed sum under
Clause 47.1 of the
Core Legal
Clauses where
consequence not
otherwise agreed
and set out in the
EMSA Plan
[Others for local
agreement]
[Insert as per
local
determination]
[Insert as per
local
determination]
[Insert as per
local
determination]
Services Handover Plan
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B4
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 8.2:
Nationally Specified Events
NOT APPLICABLE
Technical
Guidance
Reference
PHQ01
Nationally Specified
Event
Threshold
Method of
Measurement
Consequence
per breach
Ambulance Clinical
Quality-Category A 8
Minute Response Time
75 % of all Cat A
calls within 8
minutes
Performance measured
monthly with annual
reconciliation
Monthly
withholding of
2% of actual
monthly
contract value
with an end of
year
reconciliation
with 2% of the
Actual Outturn
Value of the
Agreement
retained if
annual
performance is
not met
or
the withheld
sums returned
(with no
interest) if
annual
performance is
met
PHQ02
Ambulance Clinical
Quality-Category A 19
Minute Transportation
Time
95% within 19
minutes
Performance measured
monthly with annual
reconciliation
Monthly
withholding of
2% of actual
monthly
contract value
with an end of
year
reconciliation
with 2% of the
Actual Outturn
Value of the
Agreement
retained if
annual
performance is
not met
or
the withheld
sums returned
(with no
interest) if
annual
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B5
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Technical
Guidance
Reference
Nationally Specified
Event
Threshold
Method of
Measurement
Consequence
per breach
performance is
met
PHQ03-05
Proportion of patients
receiving first definitive
treatment for cancer
within 62 days of
-
an urgent GP
referral for
suspected
cancer
Operating
standard of 85%
-
referral from an
NHS Cancer
Screening
Service
Operating
standard of 90%
-
following a
consultant’s
decision to
upgrade the
Patient priority
[Insert as per
local
determination]
Review of monthly
Service Quality
Performance Report
2% of the
Actual Outturn
Value of the
service line
revenue
PHQ06
Percentage of patients
receiving first definitive
treatment within one
month of a cancer
diagnosis
Operating
standard of 96%
Review of monthly
Service Quality
Performance Report
2% of the
Actual Outturn
Value of the
service line
revenue
PHQ07
Proportion of patients
waiting no more than
31 days for second or
subsequent cancer
treatment - surgery
Operating
standard of 94%
Review of monthly
Service Quality
Performance Report
2% of the
Actual Outturn
Value of the
service line
revenue
PHQ08
Proportion of patients
waiting no more than
31 days for second or
subsequent cancer
treatment - drug
treatments
Operating
standard of 98%
Review of monthly
Service Quality
Performance Report
2% of the
Actual Outturn
Value of the
service line
revenue
PHQ09
Proportion of patients
waiting no more than
31 days for second or
subsequent cancer
treatment (radiotherapy
treatments)
Review of monthly
Service Quality
Performance Report
2% of the
Actual Outturn
Value of the
service line
revenue
Review of monthly
report under Clause
39.1 of the Core Legal
Clauses
As set out in
Clause 43.4 of
the Core Legal
Clauses and
PHQ19-20
Percentage of patients
seen within 18 weeks in
respect of Consultantled Services to which
Operating
standard of 94%
For admitted
90% and over
And
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B6
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Technical
Guidance
Reference
Nationally Specified
Event
the 19 Weeks ReferralTo-Treatment Standard
applies
PHQ22
Threshold
Method of
Measurement
Consequence
per breach
Section B Part
8.4
For nonadmitted 95%
and over
Percentage of
diagnostic waits > 6
weeks
Operating
standard of 99%
Review of monthly
report under Clause
39.1 of the Core Legal
Clauses
2% of the
Actual Outturn
Value of the
service line
revenue
Percentage of patients
seen within 18 weeks
for direct access
audiology treatment
Operating
standard of 95%
Review of monthly
report under Clause
39.1 of the Core Legal
Clauses
2% of the
Actual Outturn
Value of the
service line
revenue
Percentage of A & E
attendances where the
patient spent four hours
or less in A & E from
arrival to transfer,
admission or discharge
Operating
standard of 95%
Review of monthly
report under Clause
39.1 of the Core Legal
Clauses
2% of the
Actual Outturn
Value of the
service line
revenue
PHQ24
Percentage of patients
seen within two weeks
of an urgent GP referral
for suspected cancer
Operating
standard of 93%
Review of monthly
Service Quality
Performance Report
2% of the
Actual Outturn
Value of the
service line
revenue
PHQ25
Percentage of patients
with breast symptoms
where cancer not
initially suspected
referred to a specialist
who are seen within
two weeks of referral
Operating
standard of 93%
Review of monthly
Service Quality
Performance Report
2% of the
Actual Outturn
Value of the
service line
revenue
PHQ26
Sleeping
Accommodation Breach
>0
Verification of the
monthly data provided
pursuant to Section B
Part 14.1 , in
accordance with
Professional Letter
Retention of
£250 per day
per patient
affected as may
be varied
pursuant to
Guidance
Failure to publish a
Declaration of
Compliance or
Declaration of NonCompliance pursuant to
Clause 30.1 of the Core
Legal Clauses
0
Publication (with easy
access for the public) of
the Declaration of
Compliance/Declaration
of Non-Compliance on
Provider’s website
Retention of up
to 1% of all
monthly sums
payable under
Clause 7
(Prices and
Payment) of the
Core Legal
Clauses for
PHQ23
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B7
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Technical
Guidance
Reference
Nationally Specified
Event
Threshold
Method of
Measurement
Consequence
per breach
each month or
part month until
either a
Declaration of
Compliance or
Declaration of
NonCompliance is
published
PHQ28
Publishing a
Declaration of NonCompliance pursuant to
Clause 30.3 of the Core
Legal Clauses
0
Publishing a
Declaration of NonCompliance
Retention of up
to 1% of all
monthly sums
payable under
Clause 7
(Prices and
Payment) of the
Core Legal
Clauses in the
month following
publication
Rates of Clostridium
difficile
[Insert as per
local
determination]
Review of monthly
report under Clause
39.1 of the Core Legal
Clauses
As set out in
Section B Part
8.5
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B8
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 8.3:
Never Events
Never Events
Threshold
Method of
Measurement
Never Event
Consequence
(per occurrence)
Wrong site surgery
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Wrong
implant/prosthesis
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Retained foreign object
post-operation
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Wrongly prepared highrisk injectable
medication
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Maladministration of
potassium-containing
solutions
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B9
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Never Events
Threshold
Method of
Measurement
Never Event
Consequence
(per occurrence)
Wrong route
administration of
chemotherapy
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Wrong route
administration of
oral/enteral treatment
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Intravenous
administration of
epidural medication
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Maladministration of
Insulin
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Overdose of midazolam
during conscious
sedation
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Opioid overdose of an
opioid-naïve Patient
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
In accordance with
applicable
Guidance, recovery
of the cost of the
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B10
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Never Events
Threshold
Method of
Measurement
Never Event
Consequence
(per occurrence)
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Inappropriate
administration of daily
oral methotrexate
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Suicide using noncollapsible rails
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Escape of a transferred
prisoner
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Falls from unrestricted
windows
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Entrapment in bedrails
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B11
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Never Events
Threshold
Method of
Measurement
Never Event
Consequence
(per occurrence)
Report
procedure or care
Transfusion of ABOincompatible blood
components
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Transplantation of ABO
incompatible organs as a
result of error
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Misplaced naso- or orogastric tubes
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Wrong gas administered
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Failure to monitor and
respond to oxygen
saturation
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Air embolism
>0
Review of reports
submitted to National
In accordance with
applicable
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B12
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Never Events
Threshold
Method of
Measurement
Never Event
Consequence
(per occurrence)
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Misidentification of
Patients
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Severe scalding of
Patients
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
Maternal death due to
post partum
haemorrhage after
elective caesarean
section
>0
Review of reports
submitted to National
Patient Safety
Agency (or successor
body)/Serious
Incidents reports and
monthly Service
Quality Performance
Report
In accordance with
applicable
Guidance, recovery
of the cost of the
procedure and no
charge to
Commissioner for
any corrective
procedure or care
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B13
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 8.4:
18 Weeks Referral-to-Treatment Standard for Consultant-led
Services Financial Adjustments Table
Percentage by which the
Provider underachieves the
18 Weeks Referral-toTreatment Standard
threshold set out in Section
B Part 8.2 for each specialty
(in respect of Consultant-led
Services to which the 18
Weeks Referral-toTreatment Standard applies)
Percentage of the revenue,
derived from the provision of
the (underachieved) specialty
in the month of the
underachievement, to be
deducted under Clause 43.4
subject to the cap of 5% of the
Contract Month Elective Care
18 Weeks Revenue pursuant
to Clause 43.6 of the Core
Legal Clauses
Up to 1%
>1% to 2%
>2% to 3%
>3% to 4%
>4% to 5%
>5% to 6%
>6% to 7%
>7% to 8%
>8% to 9%
>9% to 10%
>10%
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
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0.5%
1%
1.5%
2%
2.5%
3%
3.5%
4%
4.5%
5%
5%
B14
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 8.5:
Clostridium difficile Adjustments Tables
Table 1 - Baseline Threshold is greater than 75
Percentage by which
Provider exceeds the
Baseline Threshold
Percentage of Total Acute
Services Contract Year
Revenue to be deducted under
Clause 44.5
Up to 1%
>1% to 2%
>2%to 3%
>3% to 4%
>4% to 5%
>5% to 6%
>6% to 7%
>7% to 8%
>8% to 9%
>9% to 10%
>10%
0%
0.2%
0.4%
0.6%
0.8%
1%
1.2%
1.4%
1.6%
1.8%
2%
Table 2 Baseline Threshold is between 35 to 74 and the number of cases is greater
than 75
Percentage by which
Provider exceeds the
Baseline Threshold
Percentage of Total Acute
Services Contract Year
Revenue to be deducted under
Clause 44.6
Up to 1%
>1% to 2%
>2%to 3%
>3% to 4%
>4% to 5%
>5% to 6%
>6% to 7%
>7% to 8%
>8% to 9%
>9% to 10%
>10%
0%
0.2%
0.4%
0.6%
0.8%
1%
1.2%
1.4%
1.6%
1.8%
2%
Table 3 Baseline Threshold is between 35 to 74 and the number of cases is less than 75
Percentage by which
Provider exceeds the
Baseline Threshold
Percentage of Total Acute
Services Contract Year
Revenue to be deducted under
Clause 44.7
Up to 1%
>1% to 2%
>2% to 3%
>3% to 4%
>4% to 5%
>5% to 6%
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
0%
0.1%
0.2%
0.3%
0.4%
0.5%
B15
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Percentage by which
Provider exceeds the
Baseline Threshold
Percentage of Total Acute
Services Contract Year
Revenue to be deducted under
Clause 44.7
>6% to 7%
>7% to 8%
>8% to 9%
>9% to 10%
>10% to 11%
>11% to 12%
>12% to 13%
>13% to 14%
>14% to 15%
>15% to 16%
>16% to 17%
>17% to 18%
>18% to 19%
>19% to 20%
>20%
0.6%
0.7%
0.8%
0.9%
1%
1.1%
1.2%
1.3%
1.4%
1.5%
1.6%
1.7%
1.8%
1.9%
2%
Table 4 Baseline Threshold less than 35
Percentage by which
Provider exceeds the
Baseline Threshold
Percentage of Total Acute
Services Contract Year
Revenue to be deducted under
Clause 44.8
Up to 1%
>1% to 2%
>2% to 3%
>3% to 4%
>4% to 5%
>5% to 6%
>6% to 7%
>7% to 8%
>8% to 9%
>9% to 10%
>10% to 11%
>11% to 12%
>12% to 13%
>13% to 14%
>14% to 15%
>15% to 16%
>16% to 17%
>17% to 18%
>18% to 19%
>19% to 20%
>20% to 21%
>21% to 22%
>22% to 23%
>23% to 24%
>24% to 25%
>25% to 26%
>26% to 27%
>27% to 28%
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
0%
0.05%
0.1%
0.15%
0.2%
0.25%
0.3%
0.35%
0.4%
0.45%
0.5%
0.55%
0.6%
0.65%
0.7%
0.75%
0.8%
0.85%
0.9%
0.95%
1%
1.05%
1.1%
1.15%
1.2%
1.25%
1.3%
1.35%
B16
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Percentage by which
Provider exceeds the
Baseline Threshold
Percentage of Total Acute
Services Contract Year
Revenue to be deducted under
Clause 44.8
>28% to 29%
>29% to 30%
>30% to 31%
>31% to 32%
>32% to 33%
>33% to 34%
>34% to 35%
>35% to 36%
>36% to 37%
>37% to 38%
>38% to 39%
>39% to 40%
>40%
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
1.4%
1.45%
1.5%
1.55%
1.6%
1.65%
1.7%
1.75%
1.8%
1.85%
1.9%
1.95%
2%
B17
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 9 - QUALITY INCENTIVE SCHEMES
Section B Part 9.1:
Nationally Mandated Incentive Schemes
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B18
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 9.2:
Commissioning for Quality and Innovation (CQUIN)
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B19
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 9.3:
Locally Agreed Incentive Schemes
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B20
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 10 - ELIMINATING MIXED SEX ACCOMMODATION PLAN
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B21
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 11 - SERVICE DEVELOPMENT AND IMPROVEMENT PLAN
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B22
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 12 - SERVICE USER, CARER AND STAFF SURVEYS
The SCG will work in accordance with HFEA requirements
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B23
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 13 - CLINICAL NETWORKS AND SCREENING PROGRAMMES
NOT APPLICABLE
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B24
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
SECTION B PART 14 – REPORTING AND INFORMATION MANAGEMENT
NB: 2012/13 represents a year of transition in the development of the NHS. During 2012/13
the transition of specialised services into the NHS CB will be reflected as the Health and
Social Care Bill, which is currently making its way through the parliamentary process, is
delivered locally.
The need for reporting and information management will change during the year, the new
information flows are identified in this contract for information. These areas may not be in
operation from “day one” of the contract, but can be expected to be implemented through
contract change as the National Transition Group progress the implementation of the new
commissioning landscape.
Section B Part 14.1: National Requirements Reported Centrally
The commissioner recognises the special circumstances of the Provider in respect of
HFEA and NHS governance rules. Both parties will work within the duration of the
contract to ensure compliance with mandated HFEA information governance and NHS
reporting policy as outlined below.
1.
The Provider and Commissioner shall comply with the reporting requirements of SUS
and UNIFY2 where applicable.
2.
Compliance with the required format, schedules for delivery of data and definitions as
set out in the Information Centre guidance, Review of Central Returns (ROCR) and
all Information Standards Notices (ISNs), where applicable to the service being
provided.
3.
The Provider shall ensure that each dataset that it provides under this Agreement
contains the Organisation Data Service (ODS) code for the relevant Commissioner,
and where the Commissioner to which a dataset relates is a Specialised
Commissioning Group, or for the purposes of this Agreement hosts, represents or
acts on behalf of a Specialised Commissioning Group, the Provider shall ensure that
the dataset contains the ODS code for such Specialised Commissioning Group.
4.
The Provider shall collect and report to the Commissioner on the patient-reported
outcomes measures (PROMS) in accordance with applicable Guidance.
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B25
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 14.2:
National Requirements Reported Locally
Providers are required to submit aggregate monitoring reports showing the following:
CCG Code/Name
Donor Sperm Per Treatment
Month
Donor Embryos
First Outpatient attendance
Donor Oocytes
IUI Intrauterine insemination
Surgical Sperm Retrieval
Embryo Storage
Electro Ejaculation
Abandoned Treatment Cycles
IVF
Counselling Sessions
ICSI
Follow up Outpatient appointments
FET
1.
Monthly activity report, as described in Clause 41.9 [[Activity reporting should identify
activity charged to the commissioner (EoE SCG) or counted into the related activity
plan even where zero tariff is applied. Providers are required to provide patient level
data, equivalent to CDS format either directly or via SUS. A covering summary,
including sub total values for EoE PCTs will be included. Other breakdowns will
corresponded to the agreed Activity Plan format. Whether provided via SUS or
through local returns the submission to the commissioner will comply with the national
SUS timetable..].
2.
Monthly Service Quality Performance Report, as described in Clause 45.1, and
details of performance against the Quality Requirements, including without limitation
details of all Quality Requirements satisfied, and details of and reasons for any failure
to meet the Quality Requirements [Clinical Quality Reporting will be based on the
quality initiatives identified in clause xx.x and further elaborated in Schedule [XX]. A
monthly report identifying the quality initiative reported, existing baseline, current
performance, monthly change and expected year end outcome position will be
provided on a monthly basis. This summary will be provided with such background
information as necessary for Commissioners to validate claimed performance levels.
Quality Reporting (other than clinical) will be based on the quality initiatives identified
in the contract and further elaborated in Schedule [XX]. A monthly report identifying
the quality initiative reported, existing baseline, current performance, monthly change
and expected year end outcome position will be provided on a monthly basis. This
summary will be provided with such background information as necessary for
Commissioners to validate claimed performance levels.ly].
3.
Report monthly on performance against the HCAI Reduction Plan [CDiff together with
other HCAI are reported centrally by providers and performance managed by their
host Clinical Commissioning Group, E&N Herts CCG .. E&N Herts CCG will accept
format as agreed as a part of the contract.
4.
Equality monitoring report [Equality together with other performance measures are
reported centrally by providers and performance managed by their host Clinical
Commissioning Group, E&N Herts CCG. E&N Herts CCG will accept format as
agreed as a part of the contract.
5.
Complaints monitoring report [Complaints together with other performance measures
are reported centrally by providers and performance managed by their host Clinical
Commissioning Group, E&N Herts CCG .. E&N Herts CCG will accept format as
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B26
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
agreed as a part of the contract.
6.
Report against performance of the Service Development and Improvement Plan
(SDIP) [SDIP Reporting will be based on the various initiatives identified in clause
xx.x and further elaborated in Schedule [XX]. A monthly report identifying the SDIP
context reported, existing baseline, current performance, monthly change and
expected year end outcome position will be provided on a monthly basis. This
summary will be provided with such background information as necessary for
Commissioners to validate claimed performance levels.].
7.
Report on performance against the EMSA Plan and on any breaches of milestones
set out in the EMSA Plan [EMSA & DSSA Plans together with other performance
measures are reported centrally by providers and performance managed by their host
CCG, E&N Herts CCG .. E&N Herts CCG will accept format as agreed with the local
Host PCT Where providers can demonstrate that EMSA/DSSA Plans have been
completed this requirement can be shifted to a single annual statement].
8.
Report on Mixed Sex Associated Breaches [Mixed Sex Associated Breaches,
together with other performance measures, are reported centrally by providers and
performance managed by their host CCG, E&N Herts CCG . . E&N Herts CCG will
accept format as agreed as a part of the contract.
9.
Monthly report of local audits of the percentage of patients risk assessed for venous
thromboembolism who receive the appropriate prophylaxis in accordance with
Guidance [VTE management, together with other performance measures, are
reported centrally by providers and performance managed by their host CCG, E&N
Herts CCG . E&N Herts CCG will accept format as agreed as a part of the contract
10.
Where radiotherapy services are provided, report and provide data in accordance
with Guidance to support the Commissioners monitoring of the 31 day standard for
radiotherapy (according to which Patients should not wait more than 31 days from
Consultant referral to commencement of radiotherapy treatment) [Through
radiotherapy treatment MDS report see Section B14.3 ].
11.
In relation to the Cancer Registration dataset reporting (ISN), report on staging data
in accordance with Guidance [Cancer MDS reporting see Section B14.3 ]
12.
Report and provide monthly data and detailed information relating to violence-related
injury resulting in treatment being sought from Staff in A&E departments, Urgent Care
and Walk in Centres, and from Ambulance Services Paramedics (where the
casualties do not require A&E department, Urgent Care and Walk in Centre
attendance), to the local Community Safety Partnership (CSP) in accordance with
applicable Guidance (College of Emergency Medicine Clinical Guideline Information
Sharing to Reduce Community Violence (July 2009)). Format and method of delivery
shall be in accordance with the applicable Guidance.
13.
Where abortion services are provided, report and provide data to support the
monitoring of delivery of contraception at abortion services [Frequency (not less than
6 monthly), E&N Herts CCG will accept format as agreed as a part of the contract
14.
Monthly summary report of all incidents requiring reporting.E&N Herts CCG will
accept format as agreed as a part of the contract
15.
Report, where appropriate, performance against the 18 week Referral-to-Treatment
Standard.E&N Herts CCG will accept format as agreed as a part of the contract
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B27
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
16.
Where appropriate, report of progress against milestones in Data Quality
Improvement Plan [A monthly report identifying the Data Quality Imitative within the
plan identifying, existing baseline, current performance, monthly change and year end
outcome position will be provided on a monthly basis. This summary will be provided
with such background information as necessary for Commissioners to validate
claimed performance levels.].
17.
In light of the requirements of the Climate Change Act 2008, the Department’s
Sustainability Strategy “Taking the long term view”, and in line with the national NHS
Strategy: “Saving Carbon, Improving Health”, the Provider shall, as applicable,
demonstrate their measured progress on climate change adaptation, mitigation and
sustainable development, including performance against carbon reduction
management plans. E&N Herts CCG will accept format as agreed as a part of the
contract.
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B28
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
Section B Part 14.3:
Local Requirements Reported Locally
NB: Where, under this contract, services are not provided by the Provider then local data
flows can be ignored. However the Provider should assure themselves that a nil Return is not
required. Providers are strongly advised that, if they are in doubt, then a nil return should be
submitted.
Data flows used to support the commissioning process
1
Trusts will provide all and any information requirements as set out in the Service
Specifications.
2
Specialised commissioners require that at least 4 different types of data flow be
supplied to support the commissioning process:
a. Aggregate contract monitoring (see part B of 14.2.1)
b. Commissioning data set information submitted via the Secondary Usage
Service (SUS)
c. Subject to performance, clinical concerns or planning requirements it may be
deemed necessary to request additional data flows on an ad-hoc basis.
1.1
Aggregate contract monitoring
1.1.1
Aggregate contract monitoring reports will be issued no more than [10] working days
from the end of the month to E&N Herts CCG and will relate to activity performed in
the preceding month.
1.1.2
The report must be in Microsoft Excel format, and in the format requested by the coordinating Commissioners schedule 14.
1.2
Patient level monitoring (non-SUS flows)
1.2.1
The currency for non-SUS datasets must match the currencies specified in the activity
plan (Section B part 3). The cost of activity reported in all non-SUS datasets must be
calculated using the local tariffs (section B part 6.1)
1.2.2
Datasets must be supplied as MS Excel or .csv files, with column headers included in
the top rows.. All data-fields must be included, even if the data-field contains no
values.
1.2.3
Datasets must contain a single record for each activity unit (e.g. one record for each
drug delivered, one record for each dialysis session, one record for each registered
patient (in registration datasets), one record for each contact (community activity
dataset))
1.2.4
All data-fields in the non-SUS dataset format list are mandatory unless otherwise
stated (i.e. de-registration date or discharge can only be completed once patient has
de-registered or discharged).
1.2.5
If there is no activity for a service area for a month, Providers must still submit a 'nil'
return (i.e. must submit the dataset with data-field headers but no records). This is to
inform the commissioner that there has been no activity rather than just that the
dataset has failed to arrive.
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
GATEWAY REFERENCE: 16953
B29
2014/15 NHS STANDARD CONTRACT
FOR ACUTE, AMBULANCE, COMMUNITY AND MENTAL HEALTH
AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
1.2.6
Appendix A documents the required content of non-SUS data flows used to support
the commissioning of specialised services
1.2.7
Appendix B provides further advice and guidance relating to specific specialised
service reporting.
1.3
Data flows via secondary usage service (SUS)
1.3.1
All activity commissioned by specialised commissioners should be submitted via
SUS. The exceptions to this are high costs drugs and devices, infrastructure
payments, annual subscription charges and packages of care (although elements of
the care package should, where possible, be evidenced via the appropriate SUS data
flow).
1.3.2
In accordance with ‘The Operating Framework for the NHS in England 2012/13’ SUS
will be used to support performance monitoring, reconciliation and payment and the
commissioner will impose contract sanctions if they are not satisfied over the
completeness and quality of provider’s data submitted to SUS.
1.3.3
For services commissioned outside of PbR, providers are required to indicate that the
activity is subject to local payment rules by setting the last character of the
commissioning serial number to ‘=’, and to provide rules to commissioning and
information leads for identification of services within the SUS datasets.Levels of
compliance will be monitored by the Specialised Commissioning Group.
1.3.4.
All activity commissioned by this specialised commissioning group should have the
commissioner code shown as YDDC2 in all data flows submitted to SUS. If this code
is not used then the commissioner is unable to receive SUS data and is, therefore
unable to validate commissioned activity.
1.3.6
In SUS APC (Admitted Patient Care) data, since the payment currency is spells, the
commissioner requires that the 'YDDC2' commissioner code be assigned to the
whole spell; (i.e. there should be only one commissioner code used for all FCEs
within a multi-FCE spell – the exception to this is critical care – please see below)
1.3.7
There will be some activity for which an SCG is responsible for an unbundled portion
of care but are not responsible for the main activity (e.g. PCT may be responsible for
the APC spell, but SCG responsible for the neonatal critical care). In this case, E&N
Herts CCG requires that:
a. the commissioner code should be that of the commissioner of the main
activity (i.e. PCT)
b. the responsible CCGs ODS code (e.g. 'YDDC2') should be included in the
'copy recipient' data-field (Note: for multi-FCE spells, this CCG ODS code
should be added to all FCEs in the spell, not just the FCE to which the
unbundled HRG applies)
c. the (coordinating commissioner's) CCG's ODS code (e.g. 'YDDC2') should
be included in another 'copy recipient' data-field (for all FCEs)
1.3.8
As co-ordinating commissioner, E&N Herts CCG requires that, for all SUS (e.g.
APC, OP, A&E, CCMDS, etc.) and clinical datasets (e.g. renal, radiotherapy, etc.), for
all activity that is identified as specialised:
a. the commissioner code must be the SCG ODS code (e.g. 'YDDC2'), that
matches the CCG region within which the GP responsible for the patient's
care practices or within which the patient resides
b. the (coordinating commissioner's) E&N Herts CCG ODS code (e.g.
'YDDC2') to be included in the 'copy recipient' data-field.
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1.3.9
Commissioned activity may be provided in a hub and spoke or sub-contract
arrangement. Where treatment is delivered by a 'spoke' or sub-contracted Provider,
the 'Provider code' data-field should contain the NACS/ODS code of the contracted
Provider and the 'Treatment Site code' data-field should contain the NACS/ODS code
of the sub-contracted Provider
1.4
Patient level information to support clinical management and audit
1.4.1
In addition to national registries and databases listed in the document, E&N Herts
CCG expect Providers to contribute to the 'National Clinical Audit Support
Programmes' (NCASP) run by the Information Centre and other National programmes
where these are appropriate.
1.4.2
See also, appendix B for the list of national registries and databases.
1.5
Clinical quality and CQUIN monitoring
1.5.
Providers are required to supply information to support the monitoring of clinical
quality indicators documented in Part B section 8 and CQUIN schemes documented
in Part B section 9
2
Data quality
2.1
Data is expected to be complete and accurate on the first submission.
2.2
Where data is submitted by the provider late (i.e. after agreed submission/ inclusion
date), commissioners will require the same time period to query data as would be
available if data had been submitted on the inclusion day.
2.3
Providers will amend data following challenges, and data validation checks will be rerun against any further data submitted to ensure that challenged records have been
rectified.
2.4
The commissioner expects providers to supply high quality clinically coded activity
(procedure codes in particular) within admitted patient care and outpatient data sets
to enable SUS to assign unbundled HRGs for radiotherapy, rehabilitation, drugs and
critical care.
2.5
Mandatory fields used for Commissioning purposes
2.5.1
The provider will ensure that for all fields, 98% of records will be complete including
the use of default codes (where appropriate) and in line with data dictionary rules.
Failure to meet this standard may result in an Information Breach pursuant to clause
39.11 of the 2012/13 core legal clauses and definitions of the standard NHS contract.
2.6
NHS Numbers
2.6.1
The NHS number will be used to uniquely identify the records of patients receiving
health care within the NHS in England and will support the safe clinical use of patient
records, both within and between health care provider organisations.
2.6.2
It is mandatory to record patients NHS Number where applicable in commissioning
and clinical data flows(see National guidance):
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http://www.isb.nhs.uk/documents/isb-0149-02/dscn-322008/0149023220087guidance.pdf
2.6.3
There are exceptions where it is not possible to collect and share this number
perhaps because of clinical sensitivity (i.e. sexual health), or the number cannot be
gathered (i.e. unconscious patients in Accident and Emergency care and major
incidents) or the number does not exist (i.e. overseas patients).These exceptions are
well documented in existing national policies.
2.6.4
All records should contain a valid NHS Number Status Indicator as defined in the
Data Dictionary
2.6.5
The commissioner requires that 98% of all inpatient and outpatient activity has a valid
NHS number where applicable as indicated by the NHS Number Status Indicator.Of
the total number of records submitted, (excluding those where the NHS Number
Status Indicator is 07 - Number not present and trace not required) 98% should
contain an NHS Number.
2.6.6
All activity submitted without an NHS number will be challenged on the basis that the
payment requested cannot be confirmed as relating to a patient for whom the
commissioner is responsible. In line with the requirements of ‘The operating
Framework for the NHS in England 2012/13’ the commissioner will look to refuse
payment or impose contract sanctions where NHS number information is missing.
3
Counting methodology
3.1
There are a couple of examples where clarity is required concerning the counting of
specialised services activity in order to ensure a consistent approach across the
country.
4
Specialised services algorithm
4.1
An information algorithm is in development which describes specialised services
using OPCS, ICD, main speciality codes and treatment function codes to enable
providers to identify specialised services and flag them in their contract monitoring,
local and SUS submissions.
4.2
The latest revision of the National Algorithm is available on request from E&N Herts
CCG . Providers are encouraged to use this algorithm to identify service activity which is/will
be the responsibility of the commissioner. The need for reporting and information
management will change during the year, the new information flows are identified in this
contract for information. These areas may not be in operation from “day one” of the contract,
but can be expected to be implemented through the contract change procedure as the
National Transition Group progress the implementation of the new commissioning
landscape.
The additional data flows which will be required BEFORE 31st March 2014 are documented
but are at this stage greyed out – these clauses will be enabled as necessary within the term
of this contract upon agreement with the provider.
5
Co-ordinating commissioner arrangements
5.1
E&N Herts CCG this contract as co-ordinating commissioner. All other CGGs are
associates to this contract.
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended 04Feb 2013)
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5.2.
The information requirements in this contract (including the set of non-SUS dataset
and their formats) apply to both co-ordinating and associate commissioners.
Providers must supply the full set of non-SUS dataset in the specified format to all
commissioners containing activity details for patients who are the responsibility of GP
Practices within each CCG (see earlier note with respect to 'nil' returns).
5.3
All data queries arising from non-SUS datasets will be managed in the first instance
by the coordinating commissioner within the contracting timetable – This is
developmental and E&N Herts CCG may wish to review the out of area query
timetable in year.
6
Independent / third sector contracts
6.1
To comply with Information Governance legislation, all providers of NHS funded care
are required to register as an NHS Business Partner under the Information
Governance Statement of Compliance. This statement sets out the agreement
between the provider and NHS Connecting for Health regarding the requirement for
providers to complete the Information Governance Toolkit and nominate a Caldicott
Guardian and Senior Information Risk Owner.
6.2
Furthermore independent / third sector providers of NHS funded care are expected to
supply activity information to support the commissioning of services in the same
manner as NHS providers.
7
Information Governance
7.1
All information gathered for the purposes of reporting is subject to the requirements
set out in clause 60 , (Data Protection, Freedom of Information and Transparency) of
the core legal clauses and definition of the NHS contract and clause 76 (Compliance
with the Law).This must also apply to work carried out on behalf of the provider under
sub-contractual arrangements.
7.2
Providers are required to have nominated a Senior Information Risk Owner (SIRO), a
Caldicott Guardian and an individual responsible for assuring Information
Governance. These are identified below:
Role
Senior Information
Risk Owner
Caldicott Guardian
Name
Job Title
Contact details
Trust Information
Governance Lead
7.3
Providers are reminded that the specialised commissioning group may be required to
release information originally supplied by providers under the Freedom of Information
Act. In responding to such requests, the CCGs will adhere to patient confidentiality
and will not release commercially sensitive information. Please refer to clause 60 of
the core legal clauses and definitions of the contract.
7.4
In regard to the recording, storage, analysis and reporting of data, all providers are
required to comply with the Data Protection Act and Caldicott guidelines. This must
also apply to work carried out on behalf of the provider under sub-contractual
arrangements. In order to maintain patient confidentiality all patient identifiable
information exchanged electronically must be transmitted [to and from NHS.net
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
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accounts] or [in a safe and secure manner, ensuring data encryption where possible
and ideally transmitted to and from safe haven NHS.net accounts].
??????
7.5
E&N Herts CCG reserves the right to share all local datasets with Clinical
Commisioning Groups in the consortium and other SCG commissioners for the
purpose of auditing potential double recording / charging and to aid discussions about
clinical pathways and planning.
8
New IT systems
8.1
When providers are selecting or developing new IT systems or modifying current IT
systems, due consideration must be taken to the dataset formats and data flows
specified in this contract and in the activity plan (section B part 3)
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Section B Part 14.4:
Data Quality Improvement Plan
NOT APPLICABLE
1. Data quality improvement plan for SUS coding
Data Quality Indicator
Quality
Threshold
Method of
Measurement
Milestone
Date
Consequence
Percentage of CCG APC and
OP records with completed
NHS Number
APC 98%
Will be measured
monthly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Percentage of CCG APC
records with correct CCG
commissioner code (note: this
includes shared-care activity
submitted to SUS by a subcontracted Provider as defined
in Section 14 Part 3 para 1.3.1)
100%
Percentage of APC and OP
records with correct Treatment
Function Code (as defined in
embedded document Section
14 Part 3 para 1.3.1)
OP 98%
1 April 2012
The algorithm will be
run against national
SUS APC data to
identify specialised
service activity. The %
of records with
incorrect
commissioner codes
will be calculated for
each Provider.
Will be measured
monthly
1 April 2012
100%
Will be checked as
part of the process
above.
Will be measured
monthly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Percentage of SUS activity in
specialised services covered by
packages of care or occupied
bed day currencies correctly
excluded from PbR
(commissioner serial number
data-field ending with '=', or with
prefix i.e. 'CL&P=') (as defined
in embedded document Section
14 Part 4 appx A))
100%
Will be checked as
part of the process
above.
Will be measured
monthly
1 April 2012
The CCG will not
pay for duplicate
activity within the
scope of packages
of care. Repeat or
persistent
duplication will
trigger sanctions as
allowed within the
contract terms
Percentage change in SUS
activity and PbR cost between
inclusion date and postreconciliation inclusion date.
APC and OP data analysed
separately, each specialised
Change in
activity <1%
Will be checked as
part of the process
above.
Will be measured
monthly
1 April 2012
The CCG does not
expect significant
changes in activity
between inclusion
and reconciliation
dates. Breach will
100%
Change in
PbR cost -
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1 Oct 2012
for
Independent
sector and
community
shared-care
Providers
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
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AND LEARNING DISABILITY SERVICES
(MULTILATERAL)
service analysed separately.
<3%
trigger sanctions as
allowed within the
contract terms
Inclusion of appropriate OPCS
codes in APC and OP datasets
such that SUS-assigned
unbundled HRGs (for
radiotherapy, rehabilitation,
critical care and drugs &
devices) are suitable for
supporting payment
50%
80%
100%
Will be checked
monthly
1 July 2012
1 Oct 2012
1 Jan 2013
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Inclusion of appropriate OPCS
codes in APC and OP datasets
such that cochlear implant
bilateral procedures can be
identified
100%
Will be checked
monthly
1 Apr 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Submission of the Radiotherapy
activity in OP dataset such that
that SUS-assigned unbundled
HRGs it is suitable for
supporting payment
50%
80%
100%
Will be checked
monthly
1 Apr 2012
1 July 2012
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Correct submission of Adult
critical care data in APC dataset
such that SUS-assigned
unbundled HRGs are suitable
for supporting payment
50%
80%
100%
Will be checked
monthly
1 Apr 2012
1 July 2012
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Correct submission of
Paediatric critical care data in
APC dataset such that SUSassigned unbundled HRG are
suitable for supporting payment
50%
80%
100%
Will be checked
monthly
1 Apr 2012
1 July 2012
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Correct submission of Neonatal
critical care data in APC dataset
such that SUS-assigned
unbundled HRGs are suitable
for supporting payment
50%
80%
100%
Will be checked
monthly
1 Apr 2012
1 July 2012
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
2. Data quality improvement plan for national supporting and clinical datasets
Data Quality Indicator
Quality
Threshold
Method of
Measurement
Milestone
Date
Consequence
Submission of the Radiotherapy
dataset as specified by DSCN
22/2008
100%
Will be audited
periodically
1 April 2012
The CCG will not
pay for activity
which can not be
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validated as within
the scope of this
contract
Submission of the Adult critical
care dataset to SUS
100%
Will be audited
periodically
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Submission of the Paediatric
critical care dataset to SUS
100%
Will be audited
periodically
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Submission of the Neonatal
critical care dataset to SUS
100%
Will be audited
periodically
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Submission of the National
Renal dataset as specified by
DSCN 27/2008
100%
Will be audited
periodically
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
Submission of the National Joint
Registry dataset as specified by
DSCN 35/2003 &Amd 48/2007
100%
Will be audited
periodically
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
3. Data quality improvement plan for contributing to national registers and databases
Data Quality Indicator
Quality
Threshold
Method of
Measurement
Milestone
Date
Consequence
All BMT patients either
registered with BSBMT or
patient refusal to register shared
with CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Haemophilia patients either
registered with UKHCDO or
patient refusal to register shared
with CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
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All neuro-rehabilitation patients
either registered with UKROC or
patient refusal to register shared
with CCGs
100%
Will be checked
quarterly
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Burns patients either
registered with iBID or patient
refusal to register shared with
CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Cystic Fibrosis patients
either registered with the CF
Trust or patient refusal to
register shared with CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Renal dialysis patients either
registered with the Renal
Registry or patient refusal to
register shared with CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Transplant patients either
registered with UK Transplant or
patient refusal to register shared
with CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Cleft Lip & Palate patients
either registered with CRANE or
patient refusal to register shared
with CCGs
100%
Will be checked
quarterly
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All patients receiving IVIg either
registered on the IVIg national
database or patient refusal to
register shared with CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Paediatric critical care
patients either registered with
PICAnet or patient refusal to
register shared with CCGs
100%
Will be checked
quarterly
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Neonatal critical care
100%
Will be checked
1 Oct 2012
The CCG will not
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patients either registered with
NNAP or SEND or patient
refusal to register shared with
CCGs
quarterly
pay for activity
which can not be
validated as within
the scope of this
contract
All Major Trauma patients either
registered with TARN or patient
refusal to register shared with
CCGs
100%
Will be checked
quarterly
1 April 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
All Haemoglobinopathy patients
either registered with NHR or
patient refusal to register shared
with CCGs
100%
Will be checked
quarterly
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
4. Data quality improvement plan for local datasets
Data Quality Indicator
Quality
Threshold
Method of
Measurement
Milestone
Date
Consequence
100% compliance with the
timetable for non-SUS dataset
specified in relevant timetable
100%
Will be checked
monthly
1 Apr 2012
The CCGreserves
the right not pay for
activity which is
reported outside
the limits of the
submission
timetable
Values in non-SUS dataset are
a 100% match with values in the
monthly activity report
50% of
datasets
80%
100%
Will be checked
monthly
1 Apr 2012
The CCG will not
pay for mismatched
activity between
datasets and
monthly reporting.
Repeat or
persistent
mismatch will
trigger sanctions as
allowed within the
contract terms
Patients removed from
registration datasets once
Provider have had no contact
with the patient in the past three
month
100%
Will be checked biannually
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1 July 2012
1 Oct 2012
1 Apr 2012
1 Oct 2012
The CCG will not
pay for activity
which can not be
validated as within
the scope of this
contract
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(MULTILATERAL)
Submission timetable
Appendix A
The table below details the dates by when data-flows, reconciliation meetings and payments
will occur. The key dates are:
 The SUS inclusion date is the date by which Providers must submit all activity to SUS,
and is the date when all non-SUS reports must be received by the CCG
 The post-reconciliation inclusion date is the date by which Providers must submit all
changes in coding of activity to SUS and to the SCG (non-SUS datasets). The data
submitted by the Provider on this date is the data on which payment will be based. Data
submitted at this time must match the monthly activity report (Section B, part 14.2.1).
Please note: Section B part 8 (Quality) includes a quality metric for the percentage change in
activity between the initial dataset (5 days after the end of the month) and the inclusion date.
No changes to activity should occur after the inclusion date (this means that activity must be
correctly identified as specialised and the commissioner code correctly assigned by this date).
The only changes that should occur between the inclusion date and the post-reconciliation
inclusion date are changes to coding as a result of challenges by commissioners, or changes
agreed with commissioners.
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Initial
dataset
sent to SUS
Inclusion
date (SUS
datasets
submitted;
Non-SUS
datasets to
CCG)
First
reconciliation
point (SUS
data available
to SCG
Postreconciliation
inclusion date
(Refreshed SUS
datasets
submitted;
Refreshed nonSUS datasets to
CCG)
Final
reconciliation
point
(Refreshed
SUS data
available to
CCG
CCG provides
reconciliation
account
Reconciliation
account
agreed or
contested
April
8 May
24 May
1 June
21 June
29 June
6 July
13 July
May
8 June
21 June
29 June
20 July
30 Jul
6 Aug
13 Aug
June*
6 July
20 July
30 Jul
22 Aug
31 Aug
7 Sept
14 Sept
July
7 Aug
22 Aug
31 Aug
21 Sep
1 Oct
8 Sept
15 Oct
August
7 Sep
21 Sep
1 Oct
19 Oct
29 Oct
5 Nov
12 Nov
September*
5 Oct
19 Oct
29 Oct
22 Nov
30 Nov
7 Dec
14 Dec
October
7Nov
22 Nov
30 Nov
21 Dec
3 Jan
10 Jan
17 Jan
November
7 Dec
21 Dec
3 Jan
23 Jan
31 Jan
7 Feb
14 Feb
December*
7 Jan
23 Jan
31 Jan
22 Feb
4 Mar
11 Mar
18 Mar
January
5 Feb
22 Feb
4 Mar
22 Mar
1 Apr
9 Apr
16 Apr
February
5 Mar
14 Mar
22 Mar
19 Apr
29 Apr
7 May
14 May
March*
7 Apr
19 Apr
29 Apr
22 May
30 May
6 Jun
13 Jun
5
operational
days of end
of month
15
operational
days after
end of
month
5 operational
days after
inclusion
1 calendar
month after
inclusion point
1 calendar
month after
first
reconciliation
point (as per
SUS
timetable)
Within 5
operational
days of final
reconciliation
point
Within 5
operational
days of SCG
reconciliation
account
Month
activity
related to
Data
queries
supplied to
Trust
[10]
operational
days after
submission
Data
reconciliation
meeting
[15]
operational
days after
submission
Reconciliation
payment
complete
(assuming not
contested)
Within [20]
operational
days of
Provider
agreement to
reconciliation
account
* Four non-SUS registration datasets are only required quarterly (Haemophilia, Cleft lip & palate, Haemoglobinopathy and CF registration). The
identified dates are relevant for these datasets. SUS dates are referenced in the PbR road testing guidance for 2012/13
2014/15 NHS STANDARD CONTRACT- (MULTILATERAL)
SECTION B – THE SERVICES (Amended December 2013)
GATEWAY REFERENCE: 16953