Conclusion

 

There are many positive aspects of the current NHS payment system, but it is far from perfect. This report shows that those providing care to patients would benefit from a re-alignment of the aims of the current payment system.

The timing is right for a review of those aims. The Five year forward view established the need for innovation, through new models of care and the development of STPs. Additionally, fixing the national PbR tariff for 2 years to 2019 has allowed for stability in the system. It has also provided a period to take stock and consider the future payment system and moves towards implementing this, with minimal disruption to patient care.

The responsibility for the national payment system lies with NHS England and NHS Improvement, so the review should be initiated and overseen by them. But it must be done in full consultation with providers and commissioners of patient care, as well as patients themselves.

The principles presented here, which reflect the needs of the provider sector in delivering care, act as a guide for this review. There will not be one simple or ‘one-size-fits-all’ system for the NHS, and the optimal solution is likely to be a mixture of mechanisms. But a system designed with these principles in mind will help providers deliver high quality care to patients.

It is important to remember, however, that the payment system is just one of many tools that can enable change, and is not an end in itself.

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