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To me, the most interesting quote from this document is the view from the Sheffield Group that:

"[PbR tariff structures are] combined with funding policies or rules which mitigate or modify these payments according to service delivery plans or strategies e.g. caps on volume, outlier payments, availability payments ... these policies and rules do not adequately take complexity of care into account"

The group can't come right out and say it, but I think the problem is less about the structure PbR and the level of its tariffs and more about the circumventation of these by commissioners. For example, many commissioners impose a contractual cap on the volume of Outpatient Follow Up appointments they will pay for. For activity over this level they pay either nothing or a marginal rate which is significantly less than the "mandatory" PbR tariff for this activity.

The Sheffield Group have the advantage of greater political clout to raise this, but the issue - commissioners over-riding PbR and paying providers below what it costs them to provide a service - affects more than just these ten.

I can only hope that the greater involvement of clinicians, on both sides of the negotiating table, will lead to policies and rules in future which might save the whole health economy money rather than saving for one organisation within it at the cost of another.