A plan by NHS England to clamp down on growth in spending on specialised services during 2015-16 will shift financial risk onto providers, potentially pushing even more acute trusts into deficit.

This is the warning from senior health chiefs after the commissioning body unveiled how it expects to keep its £14bn specialised services budget under control after ending last year £377m in the red.

According to a paper outlining NHS England’s commissioning intentions for specialised services, providers will see payments squeezed and even refused if found to be treating patients who do not meet strict access criteria.

It also reveals plans to introduce “marginal tariffs” for the majority of specialised services for which national tariff prices have not yet been set.

Under marginal tariffs trusts are paid a fraction of normal prices for activity above an agreed level.

Payments will be withheld from providers who do not treat patients in line with access criteria

Payments will be withheld from providers who do not treat patients in line with access criteria

Such an approach would help contain growth and avoid “unintended disinvestment in services such as primary care and mental health”, the NHS England document states.

It would also bring the prices paid to providers for the same specialised services closer. These currently vary widely across the country.

Where tariff prices do exist for services, NHS England plans to ban any new local price modifications “until commissioner spend is within available resources”.

Existing local modifications will also be reviewed, the document states.

These modifications - known as top-up payments - are designed to take account of extra costs incurred by tertiary providers whose caseloads are more complex than the tariff accounts for. Nine trusts in central London have previously shared additional funding of up to £50m under the top-up arrangement called Project Diamond.

NHS England is not clear how widespread the use of these agreements is elsewhere.

As well as clamping down on payments to providers, NHS England also sets out plans to review provider data to ensure patients are treated in line with specified access criteria.

NHS England will in December initiate a “prioritisation round” to pinpoint which, if any, new treatments will be introduced in 2015-16.

The approach set out in the document will form the basis for NHS England’s negotiations with providers, which are due to get under way later this year.

Critics of the planned approach told HSJ it amounted to the shifting of NHS England’s specialised commissioning deficit onto providers.

Foundation Trust Network chief executive Chris Hopson said: “These commissioning intentions risk [controlling the specialised commissioning budget] at the expense of patients and specialist providers. All these intentions do is shift this risk on to NHS providers.”

Healthcare Financial Management Association’s director of policy Paul Briddock, suggested that NHS England’s view that specialised providers could absorb payment reductions did not fit with the fact that most acute trusts were in deficit at the end of this year’s first quarter.

“What you potentially do is shift a specialised commissioning deficit from one part of the system to another part of the system that’s already under the most pressure,” he added.

The paper also points to long term plans to reduce the number of providers for some specialised services on the grounds of quality and efficiency.

When choosing which trusts will become lead providers, NHS England would be “influenced by the maturity of the relationships these hospitals exhibit” over the next 12-24 months and their “shared understanding of the medium term financial context within which the whole NHS is having to operate”, the document adds.


Specialised commissioning plan 'shifts risk to providers'