Commissioners and providers were still wrangling over the controversial HRG4 tariff just days before the 13 March deadline to complete negotiations expired.

Reaching agreement over a non-mandatory tariff to cover outpatient procedures was proving a particular stumbling block.

At least one primary care trust suggested it could face a deficit next year unless a deal below the level set for the non-mandatory tariff was reached.

PCTs and trusts have been trying to agree a single price for outpatient and day case procedures on the basis that historic outpatient tariffs are too low and day case rates too high. One resource director told HSJ that although his own PCT had reached a deal with its acute trust that suited both parties, others were reporting difficulties.

Winners and losers

He said: "The point is [the outpatient tariff] is non mandatory. A number of organisations seem to be treating it as mandatory."

NHS Confederation policy director Nigel Edwards said that in spite of the two week extension granted in February, the tight deadline for negotiations meant there would "clearly be winners and losers".

He said: "I can believe this will deliver significant disruption."