Recommendation 125

Compliance with enhanced standards

In addition to their duties with regard to the fundamental standards, commissioners should be enabled to promote improvement by requiring compliance with enhanced standards or development towards higher standards. They can incentivise higher standards either financially or by other means designed to enhance the reputation and standing of clinicians and the organisations for which they work.

The NHS Standard Contract allows for agreement on a range of quality standards or development towards higher standards. Incentives should thus contribute to improved outcomes through improvement in the quality of health services for patients, their families and carers, and through reducing health inequalities.  NHS England will be setting and incentivising enhanced standards through a ‘pick-list’ of evidence based indicators for improvement, against which it and clinical commissioning groups can set improvement trajectories and a number of non-mandated best practice service specifications to use with providers. NHS England will continue to make significant funding available (up to 2% of provider contract value) for commissioners to use in setting local improvement goals.


NHS England has set and incentivised enhanced standards for 2014/15 through a ‘pick-list’ of evidence based indicators for improvement. The Commissioning for Quality and Innovation scheme for 2014/15 provides a national framework through which organisations providing healthcare services under the NHS Standard Contract can earn incentive payments of up to 2.5% of their contract value by achieving agreed national and local goals for service quality improvement. NHS England will continue to keep the provisions in the NHS Standard Contract under review.

The quality premium rewards Clinical Commissioning Groups for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities.

The quality premium paid to Clinical Commissioning Groups in 2015/16 – to reflect the quality of the health services commissioned by them in 2014/15 – will be based on six measures that cover a combination of national and local priorities. These are:

reducing potential years of lives lost through causes considered amenable to healthcare and addressing locally agreed priorities for reducing premature mortality (15 % of quality premium);

  • improving access to psychological therapies (15 % of quality premium);
  • reducing avoidable emergency admissions (25 % of quality premium);
  • addressing issues identified in the 2013/14 Friends and Family Test, supporting roll out of Friends and Family Test in 2014/15 and showing improvement in a locally selected patient experience indicator (15 % of quality premium);
  • improving the reporting of medication-related safety incidents based on a locally selected measure (15 % of quality premium);
  • a further local measure that should be based on local priorities such as those identified in joint health and wellbeing strategies (15 % of quality premium).

The quality premium will be further developed to confirm the combination of national and local priorities that will determine the amount to be paid to Clinical Commissioning Groups in 2016/17 to reflect the quality of health services commissioned in 2015/16. Details will be published alongside the NHS Standard Contract for 2015/16, and details of other incentives to improve quality.