Tories pledge marginal pricing under PbR tariff

Speaking last week at the NHS Alliance annual conference, Mr Lansley said he would reform payment by results so that it becomes a “powerful tool” for GP-led commissioning.

The burden of creating contracts for every referral was one of the things that wore down fundholding in the past. It is substantially different from that

Mr Lansley said a range of changes was needed, including basing the tariff on the most efficient providers and aligning it with patient pathways as well as procedures.

It also needed to be a maximum price, not a uniform price. “If you get to February in the financial year and you have limited budget and the hospital has capacity, you want to be able to match limited budgeting capacity on marginal pricing - and at the moment you are frustrated because you can’t negotiate around the price.”

Mr Lansley told delegates the tariff needed to be “disaggregated” to stop trusts “taking the cream off the top by doing simple procedures that are relatively cheap”. It should be aggregated “back together again along the patient pathway” so that the tariff supported the development of integrated services, he said.

He told the primary care audience that GPs would have the freedom to draw up their own contracts with providers, but there would also be standard contracts available.

“The burden of creating contracts for every referral was one of the things that wore down fundholding in the past. It is substantially different from that. I think we’ve learnt,” he said.

He added that he wanted GPs to have responsibility for commissioning services such as NHS Direct, out of hours and walk-in centres, which would be collated under the title of “urgent care” and would sit between primary care and emergency services.

Mr Lansley’s comments on payment by results follow health secretary Andy Burnham’s announcement last month that it would in future be tied more closely to quality and patient satisfaction.

HSJ revealed last week that the DH is considering capping the number of patients that each hospital will be paid in full for treating in response to concerns that attempts to cut the tariff will be met with a surge in acute activity.