Plans to increase specialised services 'top ups' next year are dropped

This follows the decision to delay implementation of a new currency framework for admitted patient care, called HRG4+, until 2017-18. An NHS England spokesman said today that changes to top-up payments were being deferred until 2017-18 for the same reasons.

The move comes just a month after Monitor and NHS England issued proposals to increase top-up payments for specialised services by more than a third from 2016-17, with new payments introduced for specialised cancer, cardiac and respiratory services.

Cuts to payments in other areas, such as paediatrics, would also have been phased in over time, under the plans.

Under the NHS tariff system, treatments are allocated into healthcare resource groups, or HRGs, which are groups of diagnoses and interventions that consume similar levels of resources. The current system is called HRG4, and HRG4+ has been designed “to better describe patient complexity and more appropriately pay for complex patients”.

The planning guidance issued to NHS organisations today said: “To support system stability, we plan to remain on HRG4 [the current system] for a further year and there will also be no changes to specialist top-ups in 2016-17; the specialised service risk share is also being suspended for 2016-17.

“We will work with stakeholders to better understand the impact of the move to HRG4+ and other related changes in 2017-18.”

A spokesman for NHS England said: “We are deferring the introduction of revised specialist service top-up arrangements until 2017-18. Before implementing HRG4+ or changes to top-ups for specialised services, we propose to continue analysing, explaining and if necessary mitigating the effects of the proposed changes.”

HSJ revealed last week that there would be no marginal rate for specialised services next year.

The guidance also confirms that NHS England is developing a single national purchasing and supply chain arrangement for high cost devices from April 2016, such as insulin pumps, bespoke prosthetics and consumables for robotic surgery.

All providers will also be expected “to report and share data on what they are paying for the top 100 most common non-pay items, and be required to only pay the best price available for the NHS”, the document says.

As previously revealed by HSJ, there will be an overall 2 per cent efficiency requirement built into the tariff proposals for 2016-17, offset by a 3.1 per cent inflation uplift, to reflect a “step change in pension-related costs”. This reflects Monitor and NHS England’s assessment of cost inflation for providers, including the effect of pension changes.

The consultation on the tariff will also include the timetable for implementing new payment approaches for mental health, the guidance says.

The “business rules” for clinical commissioning groups in 2016-17 will remain similar to those for this year, including a requirement to “increase investment in mental health services each year at a level which at least matches their overall expenditure increase”.

CCGs will be required to deliver a cumulative surplus of 1 per cent, or “at the very least, commissioners who are unable to meet the cumulative surplus requirement must deliver an in-year break-even position”.

Commissioners with a cumulative deficit will be expected to apply their increase in allocation to improving their bottom line position, other than investments by “the amount necessary to fund nationally recognised new policy requirements”.

Meanwhile, CCGs should plan to draw down all cumulative surpluses in excess of 1 per cent over the next three years, “enabling drawdown to become a more fluid mechanism for managing financial pressures across the year-end boundary”.