January 2023 - ICB ETCs - Update on Contractual Requirements
Following extensive work and discussions with DHSC and NHSE throughout 2022 regarding the challenges in executing LCRN Partner sub-contracts for ETC only payments, the CRNCC is pleased to announce that a proposed simpler contractual framework has been reviewed and agreed.
With immediate effect this letter template, which was written by the CRNCC and approved by DHSC and NHSE, can be used by LCRN Hosts when issuing ICB ETC payments where no signed sub-contract exists. For clarity, the LCRN Partner sub-contract (Category A, B or C) does not need to be issued and signed before an ICB ETC payment can be made by the LCRN Host. However, any existing sub-contracts that have been fully executed are still valid, and there is no requirement for any variation to be issued to these.
The decision to allow use of this letter to make ICB ETC payments is very much welcomed by the CRNCC, and demonstrates the continuous improvements being made to the ICB ETC service. I am sure LCRN and Partner organisations will recognise and appreciate how much this will reduce the administrative workload involved in issuing and seeking signatures on LCRN Partner sub-contracts and contract variations, as well as simplifying the process for researchers to receive ETC payments.
In situations whereby LCRN Hosts would like to implement the letter to simplify the payment method and are aware of manual workarounds in place, you are reminded that any ICB ETC payments currently with the LCRN Hosts, awaiting onward payment, should continue to be made to the organisation named on the payment schedule produced by the CRNCC. Ahead of the 2022/23 Q4 payment run, the CRNCC ETC Finance team will review studies where workarounds have been implemented, and will discuss with the study teams whether the recipient organisation should be changed.
January 2023 - ICB ETCs - Thresholds 2023/24
The CRNCC has started to receive an increasing number of queries regarding the potential thresholds for the 2023/24 financial year. NHS England (NHSE) have confirmed that the threshold calculation agreed in 2022/23 will continue until at least 2023/24.There are no plans to return to the previous threshold percentage calculations. A further statement will be supplied by NHSE in due course.
The national ICB (formerly CCG) ETC payment system, implemented in October 2018, applied a contribution threshold to NHS secondary care sites, which sites had to surpass before any ETC payments were made. This base annual ETC threshold was typically set at 0.01% of operating budgets. After discussions with partners, a decision has been made to significantly reduce the base ETC contribution threshold from 0.01% to 0.001%, which was effective from 01 April 2022. The decision to reset thresholds significantly reduced the average threshold levels for secondary care providers from an average of £40,000 to £4,000 per annum.
December 2022 - ICB ETCs - Payment model flowchart
The CRNCC are pleased to confirm a new Integrated Care Board (ICB) Excess Treatment Costs (ETC) payment model flowchart which has been published on the ETC google site. This includes payment model diagrams embedded within the PDF along with some additional descriptions and narrative to help aid understanding and formulate a more informed decision.
Should you have any queries please contact the: ETC Helpdesk (email@example.com)
August 2022 - Arrangements for non-NHS Excess Treatment Costs
From April 2022, DHSC and the NIHR are piloting interim arrangements to support non-NHS ETCs for research into public health and social care. This replaces the previous arrangements, managed by Public Health England, for supporting public health intervention costs.
Further information, including the role of the LCRNs in this process and an email address for enquiries, can be found on the NIHR website.
July 2022 - Impact of the ICS/ICBs to CCG ETC Payments
The Integrated Care Boards (Establishment) Order 2022 came into effect on 1 July 2022, and the Clinical Commissioning Groups (CCG) ceased to exist. The NIHR CRNCC has received confirmation from NHS England that the implementation of the Integrated Care Boards (ICBs) will not impact the current national ETC payment service throughout the 2022/23 financial year.
All existing contractual arrangements held by CCGs, including their bank accounts, will continue until the end of the current financial year. Therefore LCRN Host Organisations can be reassured that any existing LCRN sub-contracts (Category A, B or C) signed by CCGs are therefore still valid for this financial year. If a contract is not yet in place between the LCRN Host Organisation and the relevant CCG organisation that is due an ETC payment, we would ask that you reach out to the ICB signatory and arrange the payment through them.
May 2022 - Provider Threshold announcement FY 2022-2023
Research in the NHS is vital to improving services, care and outcomes for patients. As part of the UK’s Clinical Research Recovery, Resilience and Growth programme, which aims to deliver the Government’s research vision, NHS England and NHS Improvement (NHSE/I) are committed to supporting and enabling the NHS to place research at the heart of its work.
Funding Excess Treatment Costs (ETCs) is one of the ways that NHSE/I, aided by the National Institute for Health and Care Research (NIHR), supports non-commercial research in the NHS.
The national CCG ETC payment system, implemented in October 2018, applied a contribution threshold to NHS secondary care sites, which sites had to surpass before any ETC payments were made. This base annual ETC threshold was typically set at 0.01% of operating budgets. After discussions with partners, a decision has been made to significantly reduce the base ETC contribution threshold from 0.01% to 0.001%, effective from 01 April 2022.
The decision to reset thresholds will significantly reduce the average threshold levels for secondary care providers from an average of £40,000 to £4,000 per annum. This will not only create additional funding to sites incurring CCG ETCs, it will provide funding earlier in the financial year and create stability and assurances for sites during the budgeting stages.
Overall it is expected that this reduction will provide additional funding of £4m per annum to secondary care providers with an additional 120 NHS sites receiving payments.
The process for receiving CCG ETC payments through the national system remains unchanged.
A list of provider thresholds will be made available here as soon as possible.
NHS trusts delivering non-commercial clinical research will benefit from additional funding to deliver studies across England - following a financial policy change lowering the point at which trusts can claim back research excess treatment costs.
April 2022 - CCG Excess Treatment Costs - Payments to Higher Education Institutions
NHS England/Improvement had previously advised that Higher Education Institutions (HEIs) would be ineligible to receive CCG ETC payments for new studies from April 2022. The CRNCC can confirm this decision has been revoked with immediate effect. Organisations such as universities continue to be eligible to receive ETC CCG payments through the CCG ETC national payment system which is managed by the NIHR CRNCC.
March 2022 - CCG Excess Treatment Cost Payment and Accrual Dates
The CRNCC can confirm that the combined 2021/22 Q3 and Q4 accrual figures will be communicated to the LCRN Host Finance Managers by 23 March 2022. The schedules should be used by the LCRN Hosts and applicable Partner organisations to accrue the amounts in the year-end accounts. The NIHR ODP app, “Excess Treatment Cost 2021.qvw”, will be updated with 2020/21 Q3 and Q4 accrual data by 25 March 2022. This app can be found in https://odp.nihr.ac.uk and selecting Excess Treatment Cost from the category drop-down option.
For clarity the combined Q3 and Q4 CCG ETC payment will be made to LCRN Hosts during May 2022 and we ask that payments to LCRN Partners are made by 30 June 2022. The timelines relating to the CCG ETC payments process for 2021/22 and 2022/23 can be found on the CCG ETC Payments page of this site.
March 2022 - CCG Excess Treatment Cost Thresholds for Local Authorities
The CRNCC is pleased to confirm that the previous decision made by NHSE&I to apply ETC provider thresholds to payments applicable for Local Authority sites has since been reversed and Local Authority sites will now be exempt from the CCG ETC thresholds, backdated to April 2021. This will be reflected in the combined 2021/22 Q3 & Q4 payments, meaning those sites that received a reduction in payment in the first half of the 2021/22 will be reimbursed.
February 2022 - CCG Excess Treatment Costs Update
The 2021/22 Q3 and Q4 CCG ETC payments will be combined and paid to LCRNs in May 2022 for onward distribution to Partners by the end of June 2022. This combined payment aims to reduce the administrative burden on the LCRNs.
The Q3 payment schedules will be issued to the LCRNs week commencing 14 February 2022 as normal. It is at the LCRNs discretion whether these are forwarded to the Partners as a notification of payments that are due.
The Excess Treatment Costs 2122.qvw app will be updated with the online Q3 payment schedules week commencing 14 February also.
The Q4 accrual data will be issued to LCRNs for onward distribution to Partners in mid-March and will ensure the NHS Agreement of Balances exercise can be completed. Further information about the NHS Agreement of Balances exercise will be provided with the Q4 accrual data.
February 2021 - ‘Go Live’ of new national CCG ETC Payment System
The NIHR CRNCC is pleased to confirm that the new national payment system for CCG ETCs is now live and DHSC has been asked to make the 2020/21 Q1 and Q2 payments to the LCRNs for onward payment to sites.
Over the last year, the CRNCC has been developing a process in which CCG ETC payments can be distributed to named sites incurring the costs, rather than the recruiting sites listed in CPMS. As a result, this will reduce both the administrative burden and the requirement to have local arrangements in place to transfer payments between sites. As part of this “Phase II” project, a decision tree is used to determine which of eight new payment models should be applied. The decision tree is available on it's own page in this Google Site.
Once the Sponsor and Chief Investigator for each study on the CRN Portfolio which incurs CCG ETCs (c250+ studies) have agreed to the payment model, all site and ratio information is thoroughly checked and uploaded to a database which communicates with the NIHR Open Data Platform (ODP). The CCG ETC payments are then calculated, based on confirmed recruitment and the ETC Per Participant Value (PPV) recorded in CPMS at the time of the quarterly datacuts, and payment schedules produced which take Provider Thresholds and Minimum Payment Triggers into account.
The CRNCC will communicate the expected dates of the 2020/21 Q3 and Q4 payment dates, as well as the Q4 accrual dates in the next couple of weeks.
We would like to thank everyone who has been involved in the development of this new national payment system, and to all sites which receive CCG ETC payments for your patience whilst the system was developed.
February 2021 - CCG ETC Payments for Devolved Administration-led Studies
In October 2018 the NIHR Clinical Research Network took over the management of ETC payments for Clinical Commissioning Group (CCG) funded studies on behalf of NHS England. At the CRNCC we provide the administration for the processing for CCG ETC payments to be paid to the LCRNs on a quarterly basis in arrears. The payment schedules advise the LCRNs where the payments need to be sent to.
The CRNCC agreed to review the payment service, in order to improve the single modelling method, by developing a new alternative ETC payment model which reduces the number of transactions required to transfer funds.
As a result of this review, from April 2020 a choice of eight payment models can be selected for all NIHR Portfolio studies that are English-led. The payment model selected will ensure payments are made to the correct organisation. An ETC decision tree has been designed to enable the CRNCC and Sponsors to determine which of the eight payment models is applicable to a study.
For Devolved Administration-led studies on the NIHR Portfolio with applicable CCG ETCs that have English recruiting sites, the payment model will automatically defer to ‘Payment model 1’, i.e ETC payments are directed to the English recruitment site(s) based on the recruitment recorded against the site(s). There is no requirement for the Sponsors to determine the payment model for these DA-led studies.
If a study occurs where the CCG ETC payment applicable to the English recruiting sites should be paid to a different English site, a choice of the payment model may be considered. The CRNCC will be happy to review a situation like this and determine if a different payment model could be applied.
November 2020 - Update on Excess Treatment Costs
The ETC project phase II, in which CCG ETC payments will be calculated using one of eight payment models, is nearing its completion date. Every effort is being made to ensure we have all the information from the Sponsors, i.e. payment model confirmation, sites and applicable ratios, to make the CCG ETC payments for the 250 live studies. LCRN study teams are being included in emails chasing a response.
Part of the project is to build a new NIHR ODP app which will detail the quarterly CCG ETC payments at a site and study level. The new app will use the confirmed recruitment data and the ETC per participant value (PPV) recorded in CPMS at the time of the data cuts as well as the payment model and intervention sites selected. We are aware that a number of sites use the ODP app to assist with their financial management. However, the ODP app cannot be released until the data is complete and correct. This is anticipated to be January 2021.
Provider thresholds will continue to be applied to CCG ETC payments and will be shown in the app. For information, NHS England/Improvement is considering a reduction to the annual threshold for 2020/21 and we will provide an update about this as soon as possible.
September 2020 - Guidance for the LCRNs Regarding the CCG ETC Decision Tree
From April 2020 the CCG ETC payments aim to pay the organisations that incur the ETCs, as opposed to the previous payment model where payments were made to the recruitment site. In order to determine the correct route for payment, a decision tree has been developed that will allow the Sponsor and Chief Investigator (CI) the flexibility of picking one of eight CCG ETC payment models that best fits their study. The steps are as follows:
Once the Sponsor/CI liaises with the Lead LCRN to finalise the SoECAT and submit to CRNCC Triage, the CRNCC Triage team will assign a commissioner and inform the CRNCC Finance team of the outcome.
For CCG studies with ETCs greater than a zero value, the CRNCC Finance team will contact the Sponsor/CI to go through the decision tree and assign one of the eight payment models that best fits their study. The Lead LCRN will be copied into the emails.
When the model has been assigned, the ETC Helpdesk will email the Sponsor, CI and Lead LCRN to confirm the payment model they have agreed to and ask for further site information and payment ratios needed for that payment model. This letter will also include an illustration table for the specific payment model to show that the final numbers will work as per the SoECAT.
CCG ETC payments will be made every financial quarter depending on the recruitment recorded and confirmed on CPMS by the NIHR quarterly data cut deadlines. Where applicable, payments will be subject to any relevant provider thresholds set by NHS England/Improvement or the Minimum Payment Trigger applicable to primary care providers.
When working with the Sponsors/CIs during the completion of the SoECAT, LCRNs are asked to inform them that, for any CCG commissioned study with ETCs, the CRNCC Finance team will contact them via the ETC Helpdesk to go through the decision tree in order to assign an ETC payment model that best fits their study.
For any further detail on the payment mechanism please refer to the CCG ETC payment principles in the Process page of this Google Site.
September 2020 - Support in Making CCG ETC Payments
The CRNCC is aware that LCRNs, on occasion, cannot forward CCG ETC payments to NHS providers as they are awaiting bank details or other pertinent information. With the support of NHS England/Improvement and DHSC, this formal letter has been drafted for use by LCRN finance teams. LCRNs are encouraged to use this letter at their discretion and are requested to feedback via the ETC Helpdesk on its effectiveness.
August 2020 - Notice of Changes to the National CCG ETC Payment System
Following the recent update announced by NHS England, the CCG ETC payment process from 1 April 2020 will require Sponsors to choose a payment model that best fits their study. Further information is provided on the NIHR website.
The CRNCC will contact Sponsors over the coming months to discuss the change in the national payment method and obtain approval regarding the payment model for each study (open to recruitment) with applicable CCG ETCs.
If the CRNCC is unable to reach the Sponsor or confirmation is not provided before the 2020/21 Q2 data cut, ETC payments will continue to be paid to the recruitment sites, as per the previous model.
LCRNs are asked to share this notice widely including, but not exhaustively, with Partner organisations, Sponsors and Chief Investigators.
July 2020 - ETCs Related to Covid-19 Studies
All COVID-19 studies, including studies categorised as Urgent Public Health Research (UPH) studies, should continue to adhere to the standard processes and mechanism for ETC attribution, costing and validation by completing a SOECAT as per usual practice. ETC payments for these studies will also be made in accordance with the arrangements of the national ETC system.
For studies where CCGs are the responsible commissioner, ETC payments for COVID-19 studies will be subject to provider thresholds where applicable.
Due to the disruption arising from COVID-19, as well as enhancements that we are making to the payments process, all CCG ETC payments made by LCRNs will be suspended until at least Q2 of the financial year 2020/21. Note: This includes payments to both primary and secondary care providers.
For studies where NHS England and Improvement Specialised Commissioning is the responsible commissioner, ETC payments will be subject to specialised commissioning national finance team’s assurance review, and will take into consideration block funding arrangements that are in place to support funding flows during the COVID-19 pandemic.
February 2020 - ETC Provider Threshold Justification
We are aware from feedback that there is a misunderstanding amongst some stakeholders/NHS sites around the justification for ETC thresholds. We have been advised by NHS England that the justification for provider thresholds is:
For consistency when liaising with provider sites, please ensure that messaging around threshold justification is in line with the above advice.
Please ensure the ETC Helpdesk (firstname.lastname@example.org) is made aware of delays or situations whereby sites will not take on studies due to the ETC Provider Threshold.
February 2020 - Assistance Required from LCRNs
The ETC national payment system has been live for over 15 months, and although the service has been a success in many ways, the CRNCC is dealing with a high volume of changes to studies within CPMS that makes the ETC payments difficult to manage. LCRNs, in particular the AcoRD Specialists, can help this situation by ensuring the ETC Helpdesk (email@example.com) is notified of the following:
Situations whereby the ETC Per Patient Value is recorded in CPMS (including the initial submission) and changes to the value by the AcoRD Specialists or colleagues
Situations whereby a study (with applicable ETCs) which is active and recruiting has a change to the design (or protocol)
New studies with an ETC Per Patient Value that has been calculated using a method other than the SoECAT.