Feature / Introduction to……payment by results (5)

Payment by results (PBR) is set to alter in the next few years. Indeed, the Department of Health has already taken a significant step by introducing best practice tariffs.

These tariffs, which set prices on the cost of high-quality care rather than average cost, were introduced in 2010/11 for four high-volume service areas – cataracts, cholecystectomy, fragility hip fracture and stroke. Five service areas were added for 2011/12 and the model used for cholecystectomy, which encourages day cases, was extended to four more procedures.

The scope of PBR is widening beyond acute services, although services newly brought into PBR will not automatically have a national currency and tariff. Mental health is the next significant area, which will initially have a national currency and local prices.

The Department published a national mental health currency in 2010/11 based on care clusters, which identify patient need (community-based and inpatients) over a given period. Mental health providers must allocate patients to a care cluster by the end of this financial year, and the clusters will be used from 2012/13 as the contract currency with local prices.

 PBR is being developed in other areas, including ambulance services, palliative and end of life care, rehabilitation and specialised services, such as cystic fibrosis and spinal injuries. Development sites are working on local currencies and funding models for non-PBR work or as an alternative to services within PBR.

 In 2010 the government’s Liberating the NHS white paper signalled a speeding up of plans to introduce currencies and tariffs for community services, such as health visiting and district nursing.

A lack of consistent data for community services has made it difficult to develop currencies nationally, but in 2009 the Department outlined guidance (Transforming community services: currency and pricing options for community services) to help the NHS create local currencies and improve pricing. Nationally, the Department has published a draft currency for the healthy child programme (healthcare services for children up to five years old).

The Department is also encouraging the NHS to develop year of care tariffs for patients with complex, long-term conditions frequently readmitted to hospital.