Income for NHS Trusts

Expenditure NHS Trusts

Payment systems for Provider organisations Block A “lump-sum” payment to cover a specific or range of services, with no dependency on the quantity of demand or supply. Example: Community Services. Capitation A “lump-sum” payment linked to the size and “complexity” of a population served by a Provider. Example: GP services. Pathway of Care A single payment to cover activity related to aspects of a specific pathway of care. Example: Hospital maternity services. Payment linked to the delivery of specific performance targets. Example: GP Quality for Outcomes (QOF) – Commissioning for Quality and Innovation (CQUIN) in Acute, Community and Mental Health Services. Pay for Performance Per Diem “Lump-sum” payment per patient per day of care. Example: Critical Care services in acute sector. Activity based reimbursement based prospectively on complexity of diagnosis/treatment/patient characteristics. Example: PbR in Acute and Mental Health Services. Case Based

GMS General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities PMS Personal Medical Services Agreement (PMS) are locally agreed contracts between NHS England and GP practice. Offers greater flexibility by offering variation in the range of services provided and the financial arrangements for those services. APMS Alternative Provider Medical Services contract are allowed to be held by organisations (GMS and PMS have to be held by GPs), but are for a fixed term, (unlike GMS and PMS which are indefinite), usually 5-10 years, but more recently some 15 year contracts issued.

Quality Outcomes Framework A payment based on per-capita of registered patients at a practice (based on the Carr-Hill formula) designed to ensure that resources are directed to practice based on an estimate of their patient workload and unavoidable practice costs. Global Sum Quality Outcomes Framework Quality and Outcomes Framework (QOFF) payments which covers services such as the management of chronic diseases and implementing preventative measures such as regular blood pressure checks Payment that cover services such as childhood vaccination and immunisation schemes, extended hours access and improving patient online access. Enhanced Services Case Based MPIG payment once available to some GMS practices are being removed over a 7 year period and being reinvested in core global sum payments.

How is quality incentivised within tariff? Best practice tariff 18 areas of clinical best practice have higher prices than non-best practice. E.g. stroke care, renal dialysis, same day emergency care Commissioning for Quality and Innovation (CQUIN) 2.5% top sliced from tariff to be recovered by delivering against a range of quality improvement items. There are National and Local CQUINS which can change every year How about the relationship between efficiency and effectiveness – does efficient care mean high quality care?

NHS England & CCGs Co-Commissioning CCGs Local Authorities Capitated Payments Block/case based /capitation Pay for Performance Capitation/case-based Block/Case Based/fee for service GPs supply services via 3 possible contracts: General Medical Services (GMS) Personal Medical Services (PMS) Alternative Personal Medical Services (APMS) Quality and Outcomes Framework (QOF): Rewards practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care Enhanced services (ES): Payments linked to an enhanced level of provision above what is required under core GMS contracts. E.g. Avoiding unplanned admissions Extended hours access Learning Disabilities Enhanced services (ES): Payments linked to an enhanced level of provision above what is required under core GMS contracts. E.g. Avoiding unplanned admissions Extended hours access Learning Disabilities Public Health Community Based Services: E.g. Screening and Immunisations

Useful reading! Payment system reform to 2020: https://www.gov.uk/government/publications/reforming-the- payment-system-for-nhs-services-supporting-the-five-year- forward-view Introduction to PbR: https://www.gov.uk/government/uploads/system/uploads/atta chment_data/file/213150/PbR-Simple-Guide-FINAL.pdf General information on the current PbR tariff: https://www.gov.uk/government/collections/the-nhs-payment- system-regulating-prices-for-nhs-funded-healthcare#2016-17- payment-system