Primary Care Networks

Investment and Impact Fund for 2021/22 explained

NHS England has provided guidance on the initial phase of the Investment and Impact Fund (IIF) for 2021/22, including details of the indicators that are the focus of performance management. Read our summary below and the full guidance is available here.

Last year’s GP Contract update set out that the IIF will be worth £150 million in 2021/22, rising to at least £225 million in 2022/23 and £300 million in 2023/24.

The indicators explained in this guidance run from 1 April 2021 to 31 March 2022 and are worth £50.7m in total.

Further indicators for this year will be introduced ‘no earlier’ than October 2021, depending on the Covid pandemic situation and following further discussions with the BMA GP Committee.

Structure – domains and areas

There are two domains on ‘prevention and tackling health inequalities’ and ‘providing high quality care’, each subdivided into two areas, with a total of six indicators.

The below summarises the indicators in each area – further details of the points, thresholds and values for the flu vaccination indicators are available here.

Domain – Prevention and tackling health inequalities

Area 1 – Prevention  
VI-01: Percentage of patients aged 65 or over who received a seasonal influenza vaccination between 1 September and 31 March  
VI-02: Percentage of patients aged 18 to 64 years and in a clinical at-risk group who received a seasonal influenza vaccination between 1 September and 31 March  
VI-03: Percentage of children aged 2 to 3 who received a seasonal influenza vaccination between 1 September and 31 March  

Area 2 – Tackling health inequalities  
HI-01: Percentage of patients on the Learning Disability register aged 14 or over, who received an annual Learning Disability Health Check and a completed Health Action Plan Providing high quality care  
Domain – Providing high-quality care  

Area 1 – Personalised care  
PC-01: Percentage of patients referred to social prescribing  

Area 2 – Access
ACC-01: Confirmation that, by 30 June, all practices in the PCN have mapped all active appointment slot types to the new set of national appointment categories, and are complying with the August 2020 guidance on recording of appointments

Value of indicators

The IIF operates in a similar way to QOF, with calculation of achievement at the network level rather than practice level.

In the initial phase of the IIF for 2021/22, each PCN can earn a maximum of 225 IIF points and the value of a point will be £200 (adjusted for list size and prevalence).

The points each PCN earns for a Standard indicator (which captures the percentage of targeted cohort receiving an intervention) will depend on how their performance relates to an upper performance threshold and a lower performance threshold.

For Binary Indicators (capturing either process completed or not) each PCN will either earn no points or earn the full agreed number of points by meeting specified criterion or criteria.

For each indicator, a PCN’s achievement payment equals its achievement points multiplied by the value of an IIF point (£200.00 in 2021/22), multiplied by a list size adjustment, and in the case of Standard but not Binary indicators, multiplied by a prevalence adjustment. The value of an IIF point will be subject to annual revision.

Personalised care adjustment

This will apply as with QOF to some standard indicators – removing patients and any interventions they receive from the denominator for that indicator.

For example, for the first flu vaccination indicator – where a PCN has 1,000 patients aged 65 and over, of whom 600 received a seasonal flu vaccine, if GP IT systems record that 100 of the 1,000 patients were offered a seasonal flu vaccine but refused and it was also deemed clinically inappropriate to administer the seasonal flu vaccine to a further 100, then PCN performance in relation to indicator VI-01 would be 75% (= 600/800), not 60% (= 600/1,000).

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