Published: 06/05/2004, Volume II4, No. 5904 Page 6 7

The roll-out of payment by results could be extended by a year to allow trusts whose costs are above the current tariff levels to reduce them.

Rotherham primary care trust chief executive John McIvor told last week's HSJ commissioning conference that the Department of Health was considering a delay of the full roll-out of tariff costs to 2009, instead of 2008.

Mr McIvor's PCT is at the forefront of commissioning at tariff cost, as his PCT commissions a high proportion of its services from Rotherham General Hospitals foundation trust.

Foundation trusts are early implementers of tariff payments, and some of their services have been provided at tariff cost since 1 April.

Mr McIvor told the conference that the DoH was considering a four-year - instead of a three-year - transition to tariff. 'That will make it a little bit easier for those [providers] that are above tariff.'

But he warned that even if providers were given an extra year to hit tariff costs, it would still be a challenge and PCTs must ensure that standards did not drop.

He said: 'If you are having to drop your prices, on top of perhaps a 2-2.5 per cent cost improvement programme, how are we as PCTs going to work with those trusts to ensure they provide the quality of service that you want for your residents?'

Mr McIvor also warned that even if there was a delay in 'full' roll-out of tariff, costs would still not cover all services offered by providers and that was a weakness in the system.

He said: 'I would suggest that until we have full roll-out of tariff across the vast majority of services, there will always be opportunities for gaming and inappropriate behaviour within the system.'

A senior Department of Health source said DoH stated policy remained that roll-out would take place until 2008.He said any delay to the timetable would be 'a decision for ministers'.