LSHP Tariff Development – information for SRH services.
Why develop tariffs?
The London Sex in Our City report clearly highlighted underfunding and low levels of
investment in SRH services. Most London services are on block contracts that receive no
uplift despite increase drug costs in particular for LARC. The London SRH Tariff Project
allows for the development of prices that are setting-independent and could be used by a
variety of providers.
The London Sexual Health tariff project is key to ensuring that in the future SRH services are
appropriately remunerated for the important public health work that they do they are intended
to drive good practice and increase access to contraception and STI testing including HIV.
The following principles underpin and drive the work. The tariff prices:
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are in the best interest of patients and public health ensuring open access is maintained
promote the integration of services (SRH/GUM)
provide value for money and are affordable
do not destabilise services/providers or PCTs
provide tariffs for SRH & integrated services that are robust
The NHS White Paper „Equity and excellence: Liberating the NHS‟ recognises the financial
challenges ahead and the role QIPP (Quality, Innovation, Productivity and Prevention) can
play in driving efficiency and quality improvement. The white paper states that „ Money will
follow the patient through transparent, comprehensive and stable payment systems across the
NHS to promote high quality care, drive efficiency, support patient choice‟ and that
„Providers will be paid according to their performance. Payment should reflect outcomes, not
just activity, and provide an incentive for better quality‟.
What do tariffs actually mean?
The tariffs will be a set of payments that reflect the cost of the providing the care. Payments
are based on clinical pathways (about 150 of them) that cover the broad range of work carried
out in SRH and GUM clinics. Payment maybe by “individual pathway”, or by “bundled
pathways”. In the former there might be one payment for SDI fitting that is different from
IUD or IUS fitting; in bundled tariffs there may be the same payment for SDI, IUS and IUD.
Bundled tariffs can introduce perverse incentive that can affect patient care. The final
decision on how far to go with bundling has not been made. At the moment the agreement is
to use individual pathways.
Payments will be made according to validated activity and outcomes reported by the
providers. If your service is not able to do this then, under tariffs, your service will not
receive income.
How can I find out what the tariff prices are?
All the work so far, including pathways and indicative prices, is published at
www.pathwayanalytics.com. You or anyone else at your Trust can access this information by
registering with Pathway Analytics. Remember that the prices published there are indicative
only and will be informed and refined as more data is collected. The final prices and bundling
may be very different from these.
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What are the timescales?
The timeline is detailed in the Chart 1. The key areas are in the red boxes, these indicate that
a shadow period will commence in April and implementation from October. During the
shadow period services will submit data to enable a comparison to be made between income
on block contract and that on tariff; local impact assessments will then be made from the
commissioners and services perspectives which will inform final adjustments before services
are paid by tariff only from October 2011.
Chart 1
Timelines for London Tariff development
What about data collection?
The Tariff Data Working Group has developed the dataset required from statutory reporting
fields with a few additions. Depending on the amount of STI work done SRH services will
need to collect elements of the SHAPT (GUM) dataset. Similarly GUM will have to collect
elements of the new SRHAD dataset. There are many suitable IT systems on the market. The
manufacturers of these systems are working with the London Project to ensure they are
capable of collecting the data and reporting it for Tariff.
Trust data management leads can obtain more details on data collection form David
Harkness, Chair of the Tariff Data Working Group [ [email protected] ]
I don’t have computers in my clinic can I just ignore this?
Whilst it will be possible to collect the data required on paper based systems, this approach is
not recommended; remember no data or poor data will affect income. The approach of DH
appears to be that it is the responsibility of the provider to ensure that they have adequate data
collection facilities to enable both statutory reporting and invoicing.
If your senior Trust management are not aware of the tariff development and the implications
for the Trust and your Service you need to ensure that they are.
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Is this a London only project?
The London project has been taken on nationally by the DH PbR team and will impact on
services outside London. Implementation of the prices outside London is now planned for
April 2012, which is several months behind London.
What is de-hosting?
At the moment, services on block contracts are open access services hosted by the PCT who
funds them. The host PCT pays for the care of patients irrespective of where they live. As
part of the tariff process de-hosting has to happen. This means that services will bill the PCTs
in which their patients live. It is therefore important for the tariffs to also be introduced
outside London. As there is going to be a gap between London implementation and out of
London implementation transitionary arrangements will be put in place to ensure that services
are paid for. As part of de-hosting the relationship with local commissioners will inevitably
change.
The 48 hour access target?
The 48 hour access target for GUM has had a major impact on access to STI testing and
treatment in London, whilst as a target this is likely to disappear it will be maintained as a
quality standard that will be monitored. Once the tariff is introduced it will be extended to
SRH and integrated services as well. The final details have yet to be finalised, but for very
sessional services it is likely that so long as you can offer a service at one of the sites within
48 hours that will be acceptable. Currently only workdays are included in the 48 hour access
target calculations.
Can anything stop the tariffs happening?
In short, the answer to this is yes. Despite the short time interval to the shadow process there
are a number of things that could stop the London Tariffs being implemented on time, or at
all? These include Government policy (the White Paper is still out for consultation) or a
widespread lack of commissioner or provider support. Commissioners and providers have all
been very supportive of this process.
I hear that all tariff prices will be reduced – what are the implications of that?
It is very likely that tariffs will not be fixed in the long-term. Ways in which they might be
varied include: allowing services to offer to work at lower tariffs (competitive tendering) or
by a DH driven reduction in tariffs. The London tariffs differ from all other NHS tariffs in
that they have been developed from bottom up costing, ie by actually calculating the costs of
certain pathways; this strengthens the argument not to apply across the board reductions to
the London Tariffs. All other tariffs have been developed from a top down approach.
Wilkinson, Chris
Chair, London SH Tariff Contraceptive Working group
January 2011
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