Guidance

Appendix C: funding guidance

Published 24 April 2024

Applies to England

Introduction 

This employment advisers (EAs) in musculoskeletal (MSK) pathways funding guidance document provides: 

• an overview of the EAs in MSK funding
• details of the service development funding (SDF) payment mechanism

This funding guidance document is subject to change and updates will be circulated following any required changes. This document should also be read in conjunction with the following EAs in MSK documents:  

• prospectus
• appendix A: application guidance
• appendix B: application form
• appendix D: service specification

Funding overview

Eligible integrated care boards (ICBs) are invited to apply for funding to deliver an EAs in MSK proof of concept (PoC). ICBs who are successful will be invited to become an early adopter of 2024 PoC sites and will enter a memorandum of understanding (MoU) agreement with NHS England. The MoU is issued alongside overarching MoUs between the Department of Health and Social Care (DHSC) and NHS England - created to provide a framework for the transfer of funding, provision of leadership and obligations of each of the parties to ensure good governance of the initiative.  

Subject to the signature of the MoU, the planned funding period covers the financial years 2024 to 2025 and 2025 to 2026 with the option to extend to cover 2026 to 2028. The funding available in 2024 to 2026 for the project, allows for up to 24 EA teams of which up to 14 EA teams will commence in autumn 2024 and up to 10 from the earliest April 2025 to 2026.  

Successful PoC sites will initially enter a set-up period, with sites commencing delivery from autumn 2024. This is subject to change and dependent upon exact timings of the application process and subsequent MoU arrangements. It is envisaged that ICBs, MSK services and stakeholders will use the set-up time to begin recruitment, which could include running senior employment adviser (SEA) recruitment first, followed by SEA recruitment of Employment Advisers (EA), and to further develop and set-up the proposed delivery model in the stated MSK setting, service and geographies.  

Timeline 

• applications open: 11:55pm on 24 April 2024
• application close: 24 May 2024
• applicants notified of outcome: June 2024
• MoU agreement issued: July 2024
• MoU agreement deadline for signature and return: September 2024
• PoC implementation period: autumn 2024 to March 2026
• funding period, as agreed in MoU: 31 March 2026

Funding mechanism  

A MoU has been developed that provides an agreement between NHS England, NHS ICB and the MSK service. The MoU sets out how resources and funding will be brought together to deliver the required outputs to ensure the success of the PoC site. The ICB proposed EAs in MSK service model and accompanying detail will form part of the MoU agreement.  

NHS England will transfer the funding to ICBs through SDF allocations. This funding to ICBs is solely for delivery of EAs in MSK - it cannot be used for any other purpose. Funding will transfer during the financial year with amounts agreed between Joint Work and Health Directorate (JWHD) and ICB and a mandate transfer to NHS England to allocate to ICBs. Were ICBs not be able to fully utilise funding for the sole purpose of EA in MSK then funding will be recovered by NHS England and JWHD. 

NHS England will transfer the SDF allocation through 2 instalments each year, July, and November, with reconciliation in February. The funding amounts will be agreed between JWHD and ICB and a mandate transfer to NHS England to allocate to ICBs. 

The JWHD will work with PoC sites to monitor progress. The anticipated route for doing this is through the management information (MI), which EA teams will collect and could include assessing information, such as EA-to-patient ratios and completed patient journeys. These and other factors will inform the SDF allocation once the service is active.  

Funding available 

Guideline of budget allocated per EA team. 

Guideline of budget allocated for an example EA team starting in 2024 to 2025 

Nominal figures	2024 to 2025	2025 to 2026
EA salary (including up to 30% on-costs and up to 20% overheads)	£41,394 plus, salary uplift	£41,394  plus, salary uplift
SEA salary (including up to 30% on-costs and up to 20% overheads)	£63,927  plus, salary uplift	£63,927  plus, salary uplift
Allocation for project management support and to support integration of the EAs within the ICB or MSK service	Up to £13,000	Up to £13,000  plus, uplift
New staff set up costs per EA and SEA	£2,539	0
Total per EA team per year (includes costs, overheads, and set up costs) x4 EAs x1 SEA PM support and integration allocation in year 1 and year 2	£255,198 plus, salary uplift (includes costs, overheads, and set up costs)	£242,503  plus, salary uplift

Note: EA and SEA salaries in the table are based on NHS Agenda for Change pay scales from April 2023. An allocation for yearly salary uplifts will be available - exact uplift allocations are still to be confirmed. 

Funding, for the PoC phase, has been identified to enable ICBs and MSK services to recruit the EA team. Funding covers EA and SEA salaries, yearly on-costs (like NI and pension contributions) and overheads (training, estates), and one-off set-up costs (like IT) in the first year of each new EA team.  

Funding has also been allocated to enable each EA team to put in place project management support and to assist in the development and delivery of how EAs and the service is integrated within and communicated as part of the ICB and/or MSK service. This funding is provided for the first 2 years of each PoC EA team and is not continuous.  

The JWHD will provide support to the PoC sites, through a team of relationship managers, whose role is to facilitate implementation. The JWHD are commissioning a national level evaluation, including the collection of site-level data MI. Sites will be required to participate in the evaluation and collect a set of MI specified by the JWHD (see the ‘Evaluation, MI and reporting’ section).

MoUs must be signed by all relevant parties to receive funding for EAs in MSK.  

Eligible expenditure 

PoC sites are entitled to claim for eligible expenses, subject to the MoU agreement. 

Funding can be used for all costs directly associated with EAs in MSK. Eligible expenses include: 

• implementation costs such as project management costs and costs relating to how EAs are integrated into the clinical MSK service. This could include, where appropriate, a one-off contribution, subject to JWHD approval to the cost of enabling co-location for the EA team with the MSK service
• staffing costs, including recruitment
• marketing and advertising, including digital communication assets
• training of staff
• costs associated with Disclosure and Barring Service (DBS) checks and indemnity insurance for EA teams

Ineligible expenditure shall include, but not be limited to: 

• paid-for lobbying, which means using the SDF to fund lobbying (through an external firm or in-house staff) to undertake activities intended to influence or attempt to influence Parliament, government, or political activity; or attempting to influence legislative or regulatory action
• using the SDF to support bids for additional funding
• expenses such as for entertaining
• payments for activities of a political or exclusively religious nature
• contributions in kind
• interest payments or service charge payments for finance leases
• gifts
• statutory fines, criminal fines or penalties, civil penalties, damages, or any associated legal costs
• payments for works or activities which the SDF recipient, or any member of their partnership has a statutory duty to undertake, or that are fully funded by other sources
• bad debts to related parties
• payments for unfair dismissal or other compensation
• depreciation, amortisation, or impairment of assets owned by the SDF recipient
• the acquisition or improvement of assets by the SDF recipient
• liabilities incurred before the commencement of the SDF MoU agreement unless agreed in writing by NHS England and JWHD
• the cost of submitting a funding application

Annual funding review  

The JWHD, will review the EAs in MSK funding quarterly. This will consider the delivery of the funded activities against the agreed outputs. 

Each annual review may result in JWHD deciding that (for example, a non-exclusive list includes):  

• the funded activities and the funding agreement should continue in line with existing plans
• there should be an increase or decrease in the EAs in MSK SDF for the subsequent financial year
• the outputs should be re-profiled and agreed
• the SDF recipient should provide JWHD with a draft remedial action plan setting out the steps the SDF recipient will take to improve delivery of the funded activities
• DHSC will consider how to recover any unspent monies (as defined in the MoU agreement)
• the EAs in MSK SDF be paused or stopped in accordance with the MoU agreement

Fraud 

If the EAs in MSK PoC sites knows or suspects, or should have known or suspected, that fraudulent activity of any kind has taken place in connection with EAs in MSK, the site must notify JWHD and NHS England immediately providing full details of the fraudulent activity, including but not limited to, the nature, the scope and the total monetary value of the fraudulent activity. 

VAT 

There is no claim to VAT on the funding transferred by NHS England to EAs in MSK sites through this SDF. If PoC sites want to deliver some or all their EAs in MSK service through a delivery partner they will need to make their own assessment as to whether that delivery partner would be eligible to charge VAT and if so, whether the PoC site can reclaim this VAT from HM Revenue and Customs (HMRC). If VAT is incurred and cannot be reclaimed, PoC sites would be expected to absorb this within their maximum funding. 

Evaluation, MI and reporting   

As a condition of receiving the EAs in MSK SDF, PoC sites are required to report on the delivery of EAs in MSK, using a standard set of metrics specified by the JWHD as part of the MI data capture process. The data will be captured by sites at the individual level, using a template supplied by the JWHD, and returned to the JWHD as site-level (aggregate) data. Over time, the JWHD may want to adjust the types of metrics captured by PoC sites. 

MI data collection reports will be returned to the JWHD monthly for at least the first 6 months, (although this may change to a longer frequency - quarterly data collection, as required and instructed by JWHD). Data returned to the JWHD will be on an aggregate level. Sites will need to develop these aggregate reports from their individual-level data. Sites will collect and submit the standardised data and MI to allow the JWHD to conduct internal monitoring of the PoC. In the main, data will be collected by EAs. However, a minimum data set (5 variables) will also be collected by clinicians as part of the referral process. This will be shared with EAs and EAs will add the data to their MI template, so that it can be included in the combined MI returns to the JWHD. 

The JWHD will analyse the MI return, and will: 

• monitor progress
• engage with sites to help support improvements where necessary and through relationship managers develop remedial or improvement plans as required

Sites will also be expected to capture all EAs in MSK related expenditure over the 3-month period as a cumulative total from the start of the project against each expenditure type stated. JWHD will monitor performance of sites for the duration of the EAs in MSK project against the profile template of forecasted EAs in MSK starts, staffing level and expenditure set out following the application. Sites should notify JWHD as soon as possible of any significant changes to cost profiles. 

Areas of the MI return that the JWHD team will contact sites to discuss include: 

• staffing levels
• number of EAs in MSK starts (compared to the completed profile template provided by the site)

Where issues are identified, JWHD will work with the PoC site to provide support and agree an action plan (without affecting the rights and remedies of NHS England, the ICB, and MSK service under the MoU agreement). Sites will be able to work with their relationship manager to support the delivery of agreed processes and to provide evidence for quality assurance purposes. 

Sites are also required to participate in the national evaluation of EAs in MSK. This will be commissioned by the JWHD. Details are currently being confirmed but sites will be expected to participate in the evaluation through for example, staff interviews and surveys and facilitating contact with clients (with consent) for research purposes. Sites may also be asked to supply relevant information or documentation requested by the JWHD for the purposes of evaluating the effectiveness of EAs in MSK. 

Delivery partners 

PoC sites may outsource elements of their EAs in MSK service to one or more delivery partners as they see fit. Delivery partners will report to the ICB on delivery of the EAs in MSK service, including on agreed metrics and costings. However, it remains the responsibility of the ICB to meet all obligations of the MoU agreement. This includes effective performance management of any delivery partner the PoC sites uses to meet agreed performance expectations and to ensure eligibility criteria are met. 

Data handling and security 

Sensitive information including participant data must be collected, stored, and always used appropriately and securely. PoC sites will be required to ensure that they, and delivery partners, meet the established standards for data security (for example, ISO/IEC27001 standard), including UK GDPR and other applicable data protection legislation. 

Data protection by design principles must be embedded into the design and delivery of the service. This will include establishing appropriate procedures for information sharing between delivery partners and with the UK government (for example, for monitoring and evaluation purposes). 

Glossary of terms and abbreviations

Applicant

An eligible ICB applying for funding under this competition.

Delivery partner

A third party to whom a site may seek to outsource the delivery of some or all its EAs in MSK service.

EAs in MSK MI

Standardised individual level data set out by the JWHD and collected by EAs (plus the minimum data set to be collected by clinicians), enabling PoC sites to track and share MI with JWHD, using a template supplied by the JWHD. This will enable the JWHD to monitor delivery and outcomes. Reported to the JWHD at the aggregate level.

EAs in MSK starts

A start is defined as the point at which a patient with MSK condition starts within the EA in MSK service - with attendance at their first EA appointment.

Eligibility criteria

The eligibility criteria described in this funding guidance document which must be satisfied by a potential participant to be eligible to join the EAs in MSK programme. 

Eligible expenditure

Expenditure that can be claimed through the EAs in MSK project.

Funded activities

As described in this funding guidance document - and more particularly defined in the MoU.

Funding agreement

The MoU agreement to be entered into by NHS England and the SDF recipient (if the applicant’s application is successful), in the form provided (or to be provided) by NHS England in connection with this application process.

Funding guidance

This EAs in MSK funding guidance document.

Funding period

The 2024 to 2025 and 2025 to 2026 period during which PoC sites receive funding through the EAs in MSK project.

GDPR

GDPR (General Data Protection Regulations) and UK (United Kingdom) GDPR means the General Data Protection Regulation (EU) 2016/679, as transposed into UK national law by operation of section 3 of the European Union (Withdrawal) Act 2018, together with the Data Protection, Privacy and Electronic Communications (Amendments etc.) (EU Exit) Regulations 2019.                                     

Implementation period 

The period assigned to activity to prepare for delivery of a EAs in MSK service, for example, recruitment, set up of the model and marketing.

Ineligible expenditure

Expenditure that cannot be claimed through the EAs in MSK project.

MoU 

Provides an agreement between NHS England, NHS ICB and the MSK service and sets out how the MSK service will work to increase the number of EAs in NHS MSK pathways through EAs in MSK services PoC.

MSK

Musculoskeletal - musculoskeletal health condition can affect your joints, bones and muscles. It is one of the leading drivers of ill-health related economic inactivity.

SDF

EAs in MSK SDF which is payable pursuant to the MoU agreement.

SDF recipient

An applicant who is successful in being selected as one of the PoC sites and awarded SDF funding.