The Investment and Impact Fund (IIF) rewards PCNs for delivering objectives set out in the NHS Long Term Plan and GP contract agreement. It will operate in a similar way to QOF.
The IIF contains domains relating to the NHS ‘triple aim’ (prevention and tackling health inequalities; providing high quality care; and creating a sustainable NHS).
The IIF contains areas described by individual performance indicators, the number of which will grow during the scheme’s expansion. Each indicator is allocated a certain number of points, with the number of points indicating the relative allocation of funds. The number of points allocated to each indicator is subject to annual revision, with clear expiry dates for each indicator. Each IIF point is worth a defined amount of money. Payments are proportional to points earned, with an adjustment for list size and (where relevant) prevalence.
IIF has aspiration payments.
Funds earned via the IIF are paid partly through aspiration payments. The aspiration payment needs to be approved by the PCN’s aligned CCG before any funds are disbursed. Any adjustment to payments necessary due to a gap between aspiration and attainment will take place once annual attainment is calculated at the end of the financial year.
IIF rewards performance based on national priorities.
Indicators reward PCNs for attainment in relation to national goals. They are structured similarly to QOF, albeit with the calculation of attainment and payment at the network rather than practice level. Each indicator has a lower performance threshold below which no payment is made, and an upper-performance threshold above which no payment is made. There is a sliding scale relating attainment to reward for performance between the lower and upper thresholds. Upper-performance thresholds for achievement have been defined taking into account national targets, LTP commitments, and expert clinical advice; lower thresholds are typically based on the 40thcentile of 2018/19 performance for each indicator. These thresholds have been set to strike an appropriate balance between rewarding good performance and ensuring that all networks are able to access IIF funds. Where indicators have a lifespan of multiple years, thresholds are subject to annual review.
Eight indicators are included in 2020/21, relating to
- seasonal flu vaccination
- health checks for people with a learning disability
- social prescribing referrals
The Fund will be worth £40.5m in 2020/21, increasing to £150m in 2021/22, £225m in 2022/23, and £300m in 2023/24.
As part of the IIF, NHS England invest money based on PCNs achieving goals in certain prescribing measures, in a similar manner to how the Qualities and Outcomes (QOF) works for practices.