Published: 29/07/2004, Volume II4, No. 5916 Page 5

Trusts that deliver specialist services are to be given more time to introduce the payment by results system. Meanwhile the phasing in of the system for all trusts is to be slowed.

In a response to a lengthy consultation on the tariff-based payment system, the Department of Health says paying for specialised services will be amended because of the high fixed costs and expensive drugs often associated with carrying out such work.

A large number of respondents to the consultation exercise said they did not think the current healthcare resource groups (treatments which can be paid for under the tariff ) reflected all types of treatment. A new refined version, including specialised work, will now be published.

Work is continuing to examine how the system will be applied to specialist services, with the possibility of some work being excluded.

The report says: 'It is not likely that any single policy will be applicable to all specialised services.We are looking on a speciality-by-speciality basis to see which services can incorporate into payment by results by 2005.' It says options to be considered include lump-sum payments for large numbers of treatments, exclusion of certain HRGs from payment by results and adjustments to tariffs.

And it says that payment by results will be introduced to 25 per cent of services in April 2005, with the percentage covered increasing by a further 25 per cent annually until 2008-09. This is an amendment from the previous requirement that the system should cover around 60 per cent of all work done by 2005-06. Foundation trusts have already begun introducing payment by results.

Meanwhile, a requirement for all trusts to make efficiency gains of 3 per cent a year has been reduced to 2 per cent.

The moves were announced days before the Audit Commission published a report warning that primary care trusts could be put at risk by the implementation of the new system. Managing director for health Andy McKeon said that as demand for both elective and non-elective care is uncertain and all additional activity will have to be paid for at full price, the main risk was in the financial stability of PCTs.

He said: 'They have a commitment to pay but demand is uncertain; one trust chief executive likened their role to a hole in the wall, but with no credit limit.'

The report also warns that some trusts will face pressures to reduce their costs to match the tariff.

Ten trusts need to make savings of£10m or more to bring them into line.