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Payment system overhaul to link with performance

Payment system overhaul to link with performance


Provider payments will be “increasingly and explicitly” tied to quality of care, the new NHS England chief executive has revealed. 

Speaking at the NHS Confederation conference in Liverpool, Simon Stevens said that the far-reaching changes would improve the “sophistication” of the commissioning system. 

NHS England will be working with healthcare sector regulator Monitor to test new payment models for some elective conditions and alternative funding arrangements for emergency and urgent care. 

Different approaches to sharing utilisation risk for particular services will also be supported by NHS England. 

“As a nation we’ve just taken the unique step of entrusting frontline clinicians with two thirds of our health service funding. Many CCGs are now harnessing clinical insight and energy to drive change in their local health systems in a way that frankly has not been achievable before now.” 

Dr Andrew Davies, chair of Warrington clinical commissioning group (CCG) said that linking payments to performance can be “risky” if it is only monitored in a single pathway. 

However, he did concede that many CCGs are working towards incentivising system outcomes. 

He told The Commissioning Review: “This approach encourages associate working and joint ownership of of system level outcomes between different sectors. 

“As presented, the outline of the proposals seems a little retrograde to me, but there may be a more progressive proposal hidden in the detail.” 

Dr Amanda Doyle, chief clinical officer of Blackpool CCG and co-chair of the NHS Clinical Commissioner (NHSCC) leadership group said that the system could be worth developing if the performance measures are based on national and locally-defined criteria. 

“However any new system must be one that incentivises and assures the right behaviours, not one that is a top down performance management approach which could pitch commissioner against provider,” she said. 

Dr Doyle said that the NHSCC would strongly support the different approaches to contracting and risk utilisation that Simon Stevens set out in his speech today which emphasises the need for commissioners to be given the freedom to make local decisions in the best interest of their patients, but that CCGs must be resourced to be able to do the job.


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