Payments by results initiative could be ditched
NHS England and Monitor have suggested a national reform of the way emergency care is funded, in a bid to introduce changes put forward by the Keogh review.
Currently, A&E departments are paid on an activity based ‘payment by results’ tariff, however this system is said to “bear little or no accountability for the cost and quality performance” of the urgent and emergency care system as a whole. With a new system potentially up and running for testing in 2015/16, the health leadership bodies hope to have all emergency care services working together as a connect whole. The report added that financial incentives built into the current regime can “conflict” with the goal of providers working together to improve performance.
New payments moving forward
The new system suggested is a single payment method, that would cover all aspects of emergency care from GP’sand paramedics to specialist emergency centres. With this approach, providers would get a “substantial proportion” of their funding as a fixed lump sum, reflecting the need for urgent and emergency services to maintain constant levels of capacity, regardless of patient numbers.
As well as this, services would receive a proportion of funding based on patient volumes, partly to prevent providers from bearing all the financial risk of unexpected surges in demand from lengthening winter pressures. The fixed payments would be dependent on both the provider and the local urgent care system in which it sits meeting defined quality targets. It is hoped that this fixed system would encourage providers not to restrict access to services or to cut back on quality.
It the tests over the next couple of years prove positive, then the scheme will be rolled out nationally from 2016/17.