Network focus

The NHS response to Covid-19 has seen the usual payment by results tariff payment architecture suspended, with block contracts put in place for at least the first four months of the new financial year, writes HFMA policy and research manager Andrew Monahan (pictured). This is a sensible step in enabling organisations to free up time and devote the maximum operational effort to Covid-19 readiness and response.

But beyond the current crisis, the approach to payment will be a key component in the move to system working. The HFMA Payment Systems and Specialised Services Special Interest Group aims to provide an important finance voice in funding flows development.

Meeting three times a year, the group consists of finance professionals responsible for income or contracting from providers and commissioners, as well as representatives from NHS England and NHS Improvement, NHS Digital and NHS Specialised Services. The group aims to provide a platform for discussion on the national payment system and specialised service-related issues in England.

The meetings are an opportunity for sharing and testing ideas, most commonly from the national bodies, and to hear updates on plans such as establishing a new payment mechanism for adult critical care or chemotherapy drugs. Members – best placed to provide feedback on how theoretical changes will play out in practice – provide instant feedback on ideas.

Covid-19 permitting, later this year we expect to discuss options for new arrangements for CNST contributions. With the current funding mechanism based largely on averages across the sector and 60% of a trust’s CNST costs based on historic claims, a trust with high historic claims may not get enough funding via the national tariff.

We also hope to continue to link with counterparts responsible for costing to understand how patient-level data will support future payment mechanisms.

The blended payment approach has been described as a stepping stone from episodic payment to a mechanism better reflecting system working. With little clear definition on what that may be, the HFMA is planning a future briefing looking at system plans and the key aspects required from payment structures. We will also keep a close eye on whether any of the measures put in place to ease the pressure from Covid-19 can be used long term.