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Three new Investment and Impact Fund (IIF) indicators will be introduced in 2022/23, NHS England has confirmed.
The indicators – which will focus on Direct Oral Anticoagulants (DOAC) prescribing and FIT testing for cancer referrals – will be supported by £34.6m funding.
In a letter sent to PCNs, NHSE said that the changes will ensure more patients with suspected lower gastrointestinal cancer will see their two week wait referral accompanied by a FIT test result, and that patients with atrial fibrillation receive anticoagulation therapy.
NHSE has allocated £14.8m to each of the CVD indicators, with £5m dedicated to the cancer measure, in addition to the existing £225m already committed for the scheme.
Dr Gavin Jamie, GP finance expert and GP in Swindon, said the funding would equate to around £25,000 per average-sized PCN with 50,000 patients.
| Indicator | Description | Thresholds | Valuation |
| CVD-12 | Percentage of patients on the QOF Atrial Fibrillation register and with a CHA2DS2-VASc score of 2 or more (1 or more for patients that are not female), who were prescribed a direct-acting oral anticoagulant (DOAC), or, where a DOAC was declined or clinically unsuitable, a Vitamin K antagonist. | UT: 95% LT: 70% | £14.8m / 66 points |
| CVD-15 | Number of patients that were prescribed Edoxaban, as a percentage of patients on the QOF Atrial Fibrillation register and with a CHA2DS2-VASc score of 1 or more for men or 2 or more for women and who were prescribed a direct-acting oral anticoagulant (DOAC). | UT: 60% LT: 40% | £14.8m / 66 points |
| CAN-10 | Percentage of lower gastrointestinal two week wait (fast track) cancer referrals accompanied by a faecal immunochemical test result, with the result recorded either in the seven days leading up to the referral, or in the fourteen days after the referral | UT: 80% LT:40% (22/23), 65% (23/24) | £5.0m / 22 points |
Dr Jamie described the CVD-12 and CAN-10 indicators as ‘routine’, citing that many CCGs have been enforcing measures similar to the latter.
However, he raised concerns over the CVD-15 indicator, noting that it appeared to suggest ‘almost everyone having a DOAC should be having Edoxaban’.
He said: ‘If you’ve got a lot of patients to transfer [from their current prescription to Edoxaban] it’s going to be quite disruptive to patients and it’s going to be time consuming for practices.’
Meanwhile, the early cancer diagnosis service requirements are set to be simplified, with PCNs set to be focused on national diagnosis priorities in light of low referral rates for prostate cancer.
PCNs will be expected to develop and implement a plan to increase ‘proactive and opportunistic’ assessments for prostate cancer among groups where referral rates have not returned to their pre-pandemic level.
They will also be expected to work with local system partners to agree the PCN’s contribution to efforts to boost cervical and bowel screening uptake.
Similarly, PCNs should review their referral practice for suspected and recurrent cancers with an eye to improve referrals among people from disadvantaged areas with typically lower rates of early diagnosis.
They will also need to review use of their non-specific symptoms’ pathways to increase the number of referrals.
The updates come as part of a series of changes to the PCN DES, including that PCNs in England would need to offer routine services between 9am and 5pm on Saturdays from October.
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