1. Payment by Tariff: Widening the Market Dr Frances Howie: Assistant Director of Public Health, NHS Worcestershire.

2. Payment by Tariff The background; The benefits; The details. One small part of the whole tobacco control picture: Motivating and assisting every smoker to quit.

3. The Background Tariff for smoking services started here; Taken to the SHA, Investing for Health Programme; Developed by a Consortium of 8 PCTs across the West Midlands; Now in year 1 of implementation; Page 65 of the TC Strategy: ‘we will seek to introduce nationally the kind of stop-smoking contract currently being developed by the West Midlands SHA.’

4. The tariff: what is it? A system of payment by results; Paying a provider once a smoker has successfully quit; One payment at 4 weeks after the quit date, and one at 12 weeks (or at time of delivery if pregnant.)

5. The tariff: the benefits New providers know that funding is secure if they achieve success; Commissioners are only paying for successful outcomes; Provides a mechanism for incentivising work with particular target populations; Enables rapid development of the market and a large number of small volume organisations to enter it; Extends patient choice; Enables VCS organisations who have expertise at working with hard-to-reach populations to enter the market with simple payment methods.

6. The tariff: the details An organisation has to become accredited as a provider of NHS stop smoking services; Has to follow a detailed service specification to national standards; Training provided locally; A community contract signed (currently cumbersome and may be reviewed;)

7. The tariff: the details Support available at every stage from the Public Health Healthy Lifestyles team; Service can recruit smokers directly, or take referrals from professionals or the Healthy Lifestyles team who will discuss with the smoker the most convenient location for them; Payments at 4 and 12 weeks after the quit date; Data requirements: invoice, activity record, performance report, patient satisfaction survey.

8. The tariff: the details Success verified by carbon monoxide monitoring; Structured payments which pay more if the smoker is in a target population; Pregnant women; BME; unemployed; routine and manual workers; deprived areas; young people; severe mental health problems; hearing or visual impairment; prisoners; Must achieve 20 smokers a year to maintain competency.

9. The tariff: payments General population: £93.68 at 4 weeks; £128.81at 12 weeks; £222.49 in total; Targeted population: £135.65 at 4 weeks; £271.30 at 12 weeks; £406.95 in total; Pregnant women: general population £215.67 at 4 weeks; £395.39 at 12 weeks; £611.06 in total; Pregnant women: targeted population: £424.84 at 4 weeks; £566.45 at 12 weeks; £991.29 in total; Will be reviewed at the end of the current contracts.

10. The tariff: payments General population: 100 @ 4 weeks; 50 @ delivery: £15,808.50 a year; Targeted population: 100 @ 4 weeks; 50 @ delivery: £27,130.000.

11. The tariff: payments for pregnant women General population: 100 @ 4 weeks: £21,567; 50 @ delivery: £19,769; total = £41,336; Targeted population: 100@ 4 weeks: £42,484; 50@ delivery: ££28,322; total = £70,806.

12. Current progress The system is now agreed, and tariff rates set; No ceiling on activity; New providers entering the market, including YMCA, social housing; Recent workshop with 14 organisations interested in the next round of expressions of interest; Service specifications agreed, first contracts signed off and in place; System still being reviewed and refined with learning for NHSW, SHA, and DH.

13. The tariff: summing up Exciting new system which will: Incentivise providers to work with our target populations; Enable new providers to enter the market so that greater numbers of smokers can be served; Only pay for success; Increase patient choice; And is now recognised nationally as good practice; Spread success!