Published: 11/08/2005, Volume II5, No. 5967 Page 3

Payment by results requires commissioners and providers to become more disciplined in managing their transactions. The code of conduct issued by the Department of Health is a good stab at setting out the kind of behaviours that will be necessary if PbR is to function effectively (news, page 5).

But in seeking to provide reassurance to those at the front line, the code - perhaps inevitably - also raises further areas of uncertainty and concern.

Chief among these are: who would police the code, what kind of mechanisms would identify non-compliance, and what sort of penalties might be incurred by transgressors? The warning that 'ongoing disputes will be seen as failure' raises the prospect of central intervention. But how does that sit with the ethos of devolution?

For the code to work effectively, its impact must be balanced across commissioners and providers and it must work equitably when applied to NHS and non-NHS organisations. What force will such an - understandably -broadly drawn code have alongside legally binding contracts? The code must also work in all contexts, and not concentrate solely on elective care simply because it is first in the PbR queue.

A code of conduct for PbR is a sensible approach to a complex set of issues and will be welcomed by most HSJ readers. But it is unlikely to be the complete answer to managing this most profound of reforms.