Plans to reduce inappropriate outpatient follow-ups by introducing a block payment system from 2017-18 have been scaled back by NHS England.

Planning guidance issued today says the proposal for block payments “was not widely supported by either commissioners or providers”.

Instead, it introduces an alternative in which the costs of follow-up appointments are increasingly “bundled” into the price paid for the first outpatient attendance. This “bundling” raises the price of the first attendance, while cutting the rate paid for subsequent appointments.

Adult surgical specialties and some medical specialties, such as diabetes, cardiology and general paediatric medicine, will have 30 per cent of the costs of follow-up appointments bundled into the first attendances.

For other medical specialties such as geriatric medicine and rheumatology, prices for first attendance will be adjusted by 20 per cent.

For a range of other paediatric and oncology specialties there will be no change, with the first attendances accounting for 10 per cent of follow up costs.

The planning guidance document adds: “We encourage local systems to consider more far reaching local payment reform to complement the redesign of first outpatient appointments and introduction of advice and guidance services under the proposed new CCG CQUIN, as well as to reduce inappropriate outpatient follow-ups, through local variations.

“Where local schemes are not in place, the default will be the approach set out above.”