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Marginal Rate Credit

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
Integrated Care Co-ordinators                     69,092 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                  515,500 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                  205,572 Physio & Occupational Therapy post hospital discharge for rehabilitation in the home
Tracheostomy Services                     54,977 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 Fist Support services                  147,000 Norfolk First Support is an Adult Social Services in-house service that provides free intensive assessment and reablement in a person’s own home for up to six weeks. If, for example, a person has been in hospital and need support when returning home, Norfolk First Support will work with them to regain as much independence as possible.
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                     94,000 Clinics and self-management advice for Epilepsy sufferers in order that hospital admission can be avoided 
Hospital Ambulance Liaison Services (HALO)                  126,683 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)                  238,274 Treatment of injuries within primary care to avoid hospital A&E attendances
Older person focussed primary care service                  366,250 Primary Care schemes to improve health services for frail and elderly with the aims of preventing avoidable hospital admissions
Long Term chronic condition management   Primary Care schemes to manage long term chronic conditions and prevent avoidable hospital admissions
Thetford home oxygen assessment                     26,745 A Home Oxygen service to help patients with COPD related conditions
Extended hours DES                  307,484 Extension of GP surgery hours to avoid patients going straight to hospital
Epilepsy Nursing                     34,500 Clinics and self-management advice for Epilepsy sufferers in order that hospital admission can be avoided 
NCHC Early Intervention Team                  115,400 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.
St Nicholas hospice - palliative care                     73,247 Palliative hospice based at the WSFT site 
SOS Bus                     32,198 CCG Investment in paramedic to attend the SOS bus in Norwich to prevent A&E attendances
Total              3,786,922  
Acute Contract Marginal Rate and Readmission Credit               3,544,374 Based on the value for the major acute providers used by the CCG's patients
Variance - Adverse / (Favourable) (242,548)  


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
Care Home Pharmacy tbc

The service focuses on medicines management reviews (systems and processes) and medication reviews (clinical appropriateness) in care homes.

NB This is not an exhaustive list