FINANCE Confederation finance adviser proposes automatic system

Published: 05/05/2005, Volume II5, No. 5954 Page 6

Local spats between commissioners and providers under payment by results should be stamped out with a national central system to settle invoices and arbitrate on disputes, a conference heard last week.

NHS Confederation finance adviser John Flook made the proposal during a primary care conference held in London by the organisation. He warned that full roll-out of the system - currently delayed until April 2006 - must not be put on hold any longer if the NHS is to introduce practice-based commissioning and support a diversity of providers under patient choice.

Mr Flook said: 'We can't resolve every complex ambiguity before beginning.'

His own view was that the potential for endless disputes over treatment quantity and payments could be 'cleared up in one' through a national settlement system.

'We must move to a national, automatic system of payment by results. It should be fast and hard and will be scary for some primary care trusts that are used to poring over activity levels and debate what they are prepared to pay for. But if you fast forward three years to 2008 there will be no discussion anyway under free patient choice, so let's just clear all this up and put in a central system now, ' he said.

He added that the body charged with running such a system could also arbitrate on any payment disputes. 'A central system that deals with sanction and redress will ensure people can feel confident with payment by results, ' he said.

He advised PCTs to build on good relationships with trusts to create 'their own set of rules' where Department of Health guidance was 'not particularly helpful' on the 'disaggregation of the tariff' - where part of the treatment cost is diverted to primary care providers.

'Currently, payment by results feels like an American Wild West, a lawless world, and We are rushing over the frontier because there might be something there, ' he said.

'The fact is there will be the morally and ethically challenged providers that will get away with some stuff for a while.' But he said NHS organisations would have to set up systems for dealing with gaming because if they wait for the 'lawmakers' to ride into town they will end up 'dead'.