CRN South West Peninsula Funding Principles 2023-24

Background

1.1 Funding is allocated to the 15 Local Clinical Research Networks (LCRNs) from the NIHR Clinical Research Network National Co-ordinating Centre (CRN CC) to support activities described in the LCRN contract which includes the Performance and operating Framework (POF).

1.2 Funding is allocated to support all activities outlined in the POF which include all aspects of research delivery, Patient and Public Involvement and Engagement, Workforce development, Communications, Study Support Service, Industry and business development, and continuous improvement in research delivery.

2023/24 Funding Allocations

1.3 NHS trusts with an average CRN funding allocation over £1m in the previous five years have been assured 90% of their 2022/23 initial allocation in the 2023/24 financial year, subject to expected research delivery volume and performance being met. This multi-year funding approach requires the LCRN Leadership team to make an assessment as to whether the LCRN Partner requires the assured funding (i.e. the 90%), as a minimum, in 2023/24. This assessment - i.e. the funding allocation required by the Partner in 2023/24 - should be inherent to the LCRN’s ordinary annual local funding distribution model. The local funding distribution model will enable the LCRN Leadership team and LCRN Partnership Group to be assured that the CRN Funding allocation provided to the Partner is proportionate to the planned research activity. This assessment should also consider whether or not the LCRN Partner has contributed to CRN HLOs in the region, proportionate to the level of CRN Funding received.

As the NHS trusts in this group have consistently large portfolios and high levels of research volume, it is a reasonable expectation that all Trusts will require the 90% funding as a minimum in 2023/24. Should a case arise where the LCRN Leadership team considers that a 2023/24 initial allocation below the 90% value is appropriate, this case should be referred to and discussed with the Coordinating Centre at the proposal stage (i.e. in advance of submission to the LCRN Partnership Group).

1.4 The national model was reviewed in 2019/20 and it was agreed that LCRNs be given an initial allocation, with 80% ‘fixed’ until 31 March 2023 using the 2018/19 allocations as the baseline. A variable element (20%) was then used to incentivise and reward against performance related to the high-level objectives and CRN speciality objectives in 2019/20 and in 2020/21 linked to an additional objective for research targeting linked to performance in high priority areas – asthma, cancer, COPD, dementia, diabetes, heart failure, mental health common, mental health severe and stroke. Each of these were allocated 4% of the 20%.

1.5 Funding in 2021.22 was allocated in 3 ways. All LCRNs received a flat budget based on their 2020/21 budget which not linked to any performance metrics because of the impact of COVID. Additional funding was then also given to alleviate cost pressures and support retention (£7.46m nationally) and funding to support staff retention where posts were at risk (£10m nationally). This funding was allocated as a percentage of the initial 2020.21 allocation. Additional funding was then given to all LCRNs to support the transformation of research delivery. This funding was ring fenced to support building a new workforce, a CRN Direct Delivery Team which will provide additional capacity and capability to deliver priority research studies in out of hospital settings. This is considered a 3-year initiative.

1.6 DHSC also provided separate funding to the LCRN host organisation for the provision of services related to managing excess treatment costs.

1.7 DHSC also provided funding for Public health prevention research which is a separate allocation.

1.8 No national contingency budget is held and LCRNS are expected to achieve POF objectives within their fixed allocation. This includes funding the host function; core leadership team; study support service; workforce development and training and education; research specialty leads; Industry and business development; communications; business intelligence; finance; information and communications technology; patient and public involvement and engagement; and continuous improvement in research delivery.

1.9 Following national guidance, the main principle of the local allocation is that a pass- through model is not adopted, account will be taken of local knowledge including local and national priorities, to resource flexibly to support continued activity as well as to support an increase in activity. Strategically, allocations will follow a 'necessary and sufficient' approach with the requirement to maintain capacity, capability and stability.

1.10 Locally there is no imperative to follow the principles of the national model and no expectation that the same methodology is used. In proposing a local model therefore, the local network needs to be cognisant of local issues, use local intelligence to inform allocation, look historically to ascertain which investment has supported excellence in delivery and meet the requirements of the strategic direction of the LCRN.

1.11 The principles being proposed in this local model are informed by what is currently known about changes in the national model.

1.12 In order to develop the SWP proposal a funding model group was again established (Appendix A for membership). The group met between July 2022 to October 2022 to review funding principles, commission options appraisals of elements of the model and review analysis of investment and performance where appropriate.

Proposed Funding Allocation Principles and Rationale 2023-24

2.0 The following are the proposed guiding principles of the funding model:

A. Funding is used for permitted activities as outlined in the Performance and Operating Framework which forms part of the LCRN and Partner Organisation (PO) contracts, investment is monitored to ensure value for money Rationale: LCRNs have contractual obligations to deliver objectives as set out in the POF; these are refreshed annually and funding will therefore need to be allocated to ensure these objectives are met. The majority of funding is allocated at the start of the financial year (FY); as payment is made monthly there is the ability to move funds during year for example if a post is not appointed or if a study does not open or if performance is not as anticipated.

B. The majority of CRN SWP funds are used to support staff costs, stability in this funding to support staff retention is therefore desirable, although this must be balanced with performance. Funding allocations rise and fall and patient pathways change, therefore the CRNSWP may be required to respond to fluctuations in the national allocation, the region’s activity, cost pressures and strategic objectives.

C. Consideration is given to the NIHR High Level Objectives (HLO’s) as set out in the Performance and Operating Framework. To note the HLOs may not be agreed until after these principles are agreed so it may be necessary to change.

Rationale: In order to achieve HLOs it is necessary to target resource to achieve objectives. It is necessary therefore to be cognisant of HLOs when making allocations in order to meet objectives. The HLOs are subject to change so allocations may be reviewed in the context of the finally agreed HLOs.

D. Consideration is given to the NIHR Specialty mandatory requirements as set out in the Performance and Operating Framework. Rationale: In order to achieve the mandatory requirements, it is necessary to review any changes to these once the final POF is released.

E. Consideration is given to the elements identified as informing performance related funding nationally or national strategic funding top slice Rationale: It may be necessary to top slice resource to ensure the ability of the network to gain additional funding for the performance elements is maximised or to demonstrate impact against strategic initiatives such as research targeting.

F. Funding is necessary and sufficient knowledge of the ‘actual’ requirements to deliver the portfolio are considered. Rationale: The network has good regional oversight of the actual resource requirements for delivery and will use data from multiple sources to inform allocations

G. Any Partner Organisations in receipt of funds >£50k provide a full annual plan outlining proposed use of funds and the plan the organisation has to achieve contractual requirements. Rationale: PO’s in receipt of >£50k are category A partners which is the ‘step down’ contract from the DHSC to Host RDUH. As such they are contractually obliged to support objectives and assurances as set out in the POF. In order to determine that POs have considered the POF and that funds will support POF delivery, a plan is required to provide assurance.

H. Funding is provided to support defined contractual requirements

1. Host Function
2. LCRN Leadership and management
3. Local Speciality Research Leads
4. Cross cutting obligations including Local Portfolio Management System
5. (LPMS); Communications; Continuous Improvement; PPIE; Workforce
6. Development and training; Study Support Service; finance; business
7. Intelligence

Rationale: There are defined allocations for two elements of LCRN funding the Host function, and LCRN Leadership and management. LCRNs are required to have a Clinical Leadership Group within the governance structure formed with Clinical Research Specialty Leads, in CRN SWP there are five and they support a cluster of defined specialty areas or themes, there are also one Lead Research Nurse and one R&D manager on a rotational basis. There is also a requirement for Local Specialty Research Leads (LSRLs) for all 30 specialty areas and sub-specialty leads for some of these specialties. Funding for these roles ranges from 0.25-1.5PA/equivalent determined by required activity for that specialty and linked to strategic investment. There is a requirement to have a LSRL in all 30 specialities, have research champions in a number of others and to support speciality leadership in new areas such as social care. The POF also stipulates defined study support service, communications, continuous improvement, PPIE and workforce development requirements and that there is an LPMS, staff resource and non-staff funding is reserved for these activities and is set annually based on POF requirements.

I: Top Slice - Clinical Support Team (Primary care/community)

Rationale: The Clinical Support Team (CST) which now form part of the larger Agile workforce is a centrally managed resource with registered and unregistered clinical and non-clinical delivery staff working predominantly in primary and community care, the team can also support all other providers and as the portfolio expands will support public health and social care research. The flexibility of this team in being regionally based enables targeted time limited support with organisations provided with resource, staff, as opposed to funding which is then organisationally bound. This top slice is proposed to remain the same so that the transformational monies provide additional capacity.

J. Top slice Research Site Initiative (RSI) £305K. Rationale: High Level Objective 3c is for 45% of general practices to be recruiting to NIHR studies. To support this objective the Research Site Initiative (RSI) provides funding currently set at three levels to support practices to engage with research (e.g. undertake GCP training, complete EOI). CST support will be considered when determining the level of RSI. The transformation of research delivery may require additional resource to be assigned to the RSI scheme to support delivery of research in out of hospital settings. This will be carefully managed to ensure that the portfolio reflects the need for this increase.

K. Top slice Primary Care service support costs (SSC) Rationale: SSC are paid to primary care, community providers and non-NHS providers via a triggered payment process based on funding for study set up and then a per patient allocation paid once activity seen in ODP quarterly in arrears. This process is run by the Host for and allows tight budget management; £90k is reserved and released to contingency in year if this level of allocation is not required. Slippage from the service support budget should be initially prioritised for non-nhs settings and primary care.

L. Top slice for Regional Genetics Service £36,750.

Rationale: The RDUH is the regional provider of the genetics service and therefore has an allocation to reflect that this regional team will support recruitment across the region. The level of funding will be based on actual activity to inform required ongoing funding and the study pipeline.

M. Top slice for South Western Ambulance Service NHS Trust

Rationale: SWASFT is supported with a 0.5 WTE research manager and research paramedic support (£44k) as well as SSC. This is based on actual requirement as opposed to any ABF model which previously would have resulted in disproportionality high allocation. In setting the allocation, activity and the study pipeline will be considered.

N. Strategic funding Underserved

Rationale: One of the NIHR seven areas of strategic focus is bringing clinical and applied research to underserved communities with a requirement that each LCRN supports a 2% top slice of budget to support this agenda. The CRN core team have a number of projects to support this through their plans for PPIE, communications and Business Intelligence and so staff resources are already used to meet part of the 2% requirement. Other strategic initiatives can be aligned to support this agenda whilst also supporting wider remits.

Allocation to all specialty research leads would remain the same for the last year of contract pending a review in line with new contract requirements in 2024.

(i) The Research Associate Programme (£120k) will be top sliced from the budget to support growth in research in defined speciality areas to meet the underserved agenda and it also supports workforce capacity building. The funding allocated by the CRN for the RA programme allows staff to gain portfolio skills whilst also developing their skill base to become PIs and potentially CIs.

(ii) 70@70 legacy project – this project was created last year to support capacity building in the nursing and midwifery workforce and to support embedding research. It is a joint initiative with Trusts and previous 70@70 leaders. It was agreed that this would be increased from £60K to £90K in order to expand on this programme of activity reaching out to community nurses and nurse practitioners within Primary Care.

(iii) First steps – This is a new support programme for research staff in local government and/or voluntary sector. A sum of £40k has been top sliced from the budget.

Rationale: The need to build research capacity to support future studies outside of hospital settings in specifically in the local authority/voluntary sector is an important remit of the CRN. This programme allows the SWP to develop capacity to support future studies. Social Work and Public Health will be specifically targeted with an aim to ignite passion and interest in research and enhance motivation, skills and knowledge so that a pathway to a future career in health and social care research can be supported.

P. Contingency £30k

Rationale: To cover unexpected costs. Account will be taken of Trust RCF and commercial activity when considering any contingency applications. All applicants must provide explicit assurance that funds will not be used for CIP.

R. Transformation of Research Delivery £833k

Rationale. The separate budget for transformation of Research Delivery will be ring fenced for this project. There may be opportunities for Partner Organisations to bid for monies to support this transformation agenda. This will be further clarified through the Transformational programme board which will outline the plans for next year. The funding model working group were asked to agree the following to embed in the principles:

Recommendations from the funding model

• Taking into consideration that this is the last year of the current NIHR contract and the pressures experienced across all NHS services, the funding model working group have acknowledged the need for stability in funding for the 2023/24 budget. The pay award increases for core team staff and the POF requirement to appoint a 0.4 wte Chief Nurse as part of the LCRN senior management team will mean that the non-recurrent funding will be reduced but the recurrent funding to all organisations will remain the same.
• Distribution of the non-recurrent funding will be a percentage attributed in line with initial funding allocation. Non-recurrent funding will not be allocated against performance metrics.
• The funding model working group agreed the top slices for the strategic funding and other top slices.

• It was agreed that ‘smaller’ organisations in receipt of less than £400k would be protected as they are unable to generate commercial activity to offset any decrease.

• Any slippage in SSCs will be used to support non NHS activity.This would be initially reviewed at Quarter 1