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Working together for excellent healthcare in North Norfolk and rural Broadland



Marginal Rate Credit (MRC)


The  ‘Guidance for commissioners on the marginal rate emergency rule and 30-day readmission rule’ document (non-statutory – published November 2016) suggested that commissioners should disclose on their website how they invested the Marginal Rate credit in accordance with the following : “The 30% of the value of emergency admissions above a provider’s baseline that is retained by commissioners should be spent on managing the demand for admitted emergency care.”

The CCG continues to follow this guidance as good practice.

Schemes commissioned in 2017/18 to reduce avoidable Non-Elective Admissions, improve emergency flow and discharges:

  £ Description
NFS Falls   Service / Crisis Response                           91,639 Provides   services from support workers trained to deal with crisis situations, to   avoid unnecessary hospital, residential or nursing home admissions.
Integrated   Care Co-ordinators                        225,115 ICC's   play a vital role between the patient and the organisations best placed to   provide their care. This involves co-ordinated Multi Disciplinary Teams   (MDTs), including  GPs, Mental Health   services, Social care and Healthcare representatives
Care at Home                        229,600 The   service provides short periods of 24 hour care to patients in their own homes   to avoid unnecessary admissions to hospital and where appropriate to   facilitate early discharge from hospital
Home Based   Therapy                        193,716 Physio   & Occupational Therapy post hospital discharge for rehabilitation in the   home
Tracheostomy   Services                           51,732 Outreach   into the community and care homes training and monitoring of Tracheostomy   services
Supported Care   team                    1,190,000 NCH&C   & NCC Clinicians and domiciliary care used as a rapid response to people   in "crisis" with a specific aim to keep them out of hospital
Norfolk First   Support (NFS) services                        147,000 Norfolk   First Support is an Adult Social Services in-house service that provides   intensive assessment and reablement in a person’s own home for up to six   weeks. 
Falls Vehicle   (EEAST & NCH&C)                        167,000 Rapid   response to support patients in their homes, who have fallen to provide care   and Admission avoidance.
A&E   Frequent Flyers                           23,000 Provide   support and positive intervention for people that frequently attend Accident   and emergency departments
Community   Epilepsy Service                           55,600 Clinics   and self-management advice for Epilepsy sufferers in order that hospital   admission can be avoided 
Hospital   Ambulance Liaison Services (HALO)                        101,007 Hospital   Ambulance Liaison Officers facilitate the flow of patients arriving by   ambulance at hospital. To prevent against unduly hospital admission delays   for patients.
Minor   injuries Local Enhance Service (LES)                        169,271 Treatment   of injuries within primary care to avoid hospital A&E attendances
Long Term   chronic condition management                        690,463 Primary   Care schemes to manage long term chronic conditions and prevent avoidable   hospital admissions
Thetford home   oxygen assessment   A   Home Oxygen service to help patients with COPD related conditions
Extended   hours DES                        235,128 Extension   of GP surgery hours to avoid patients going straight to hospital
Epilepsy   Nursing                           24,600 Clinics   and self-management advice for Epilepsy sufferers in order that hospital   admission can be avoided 
NCHC Early   Intervention Team                        123,800 EIT   service to minimise the conversion of A&E attendees to unplanned acute   admissions by facilitating successful discharges from the UCC / A&E for   people who could either be supported at home or “stepped up” into a   procured/spot-purchased bed or community inpatient unit.
SOS Bus                           27,879 CCG   Investment in paramedic to attend the SOS bus in Norwich to prevent A&E   attendances
Total                    3,746,550  
Acute   Contract Marginal Rate and Readmission Credit                     3,046,623 Based   on the value for the major acute providers used by the CCG's patients
Variance -   Adverse / (Favourable) (699,927)  


The vast majority of these schemes have been committed to for 2018/19 and in addition the following schemes are in development and expected to go live in 2018-19:

Palliative   services tbc Palliative   service designed to provide a “hospice at home” service to patients who would   rather have the palliative care at home as opposed to an acute hospital
Community   Pharmacy tbc Increasing   the community pharmacy technician resource in primary care to further enhance   effective prescribingto tackle preventable health conditions and illness   esclalations
Care Home   Pharmacy tbc The   service focuses on medicines management reviews (systems and processes) and   medication reviews (clinical appropriateness) in care homes.
NNPC Care Home tbc To   implement a team and way of working that will reduce admissions to an acute   setting by developing a more targeted approach (alongside practices) to the   care homes with higher rates of admission or anomalies in presenting   conditions


NB This is not an exhaustive list