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Many people have heard me say that PbR is far from perfect but it is a lot better than the block contract approach we used to have - principally because it makes everyone focus on the pathways a patient is on, especially where it is high cost.

As such I welcome the comment “If the tariff serves your purposes use it. If it doesn’t, create a different community tariff or an unbundled tariff” - I always see PbR as a useful level/facilitator and there is loads that can be done with it.

Having worked with PbR for almost 9 years I have never found a situation where PbR prevents a solution being put in place and usually, albeit sometimes with some creative thinking, it puts the financial levers in place to help new solutions be implemented.

So not perfect but definitely usable...