A Simple Guide to Payment by Results

The aim of this guide is to provide an introduction for newcomers to PbR. The version available via the link below is an update to the guide published September 2010; and reflects changes to PbR arrangements in 2011-12.

Please note: this document is for print purposes only, as it has not been fully tagged for accessibility.

Download A simple guide to Payment by Results, July 2011 version (PDF, 1084K

Confirmation of Payment by Results arrangements for 2012-13

Confirmation of the arrangements for Payment by Results (PbR) in 2012-13 is available. The road test of the draft 2012-13 PbR Guidance concluded on 20 January 2012 and a number of changes have been made as a result of this feedback.

Read David Flory’s covering letter on the publication of the final 2012-13 Payment by Results package. Access the information and guidance in support of Payment by Results in 2012-13 see below:

PbR operational guidance and tariffs

The 2012-13 PbR guidance has been clarified and expanded in a number of areas, in response to feedback received at road-test which concluded on 20 January 2012.

view the PbR Guidance, PbR Code of Conduct and the tariff information spreadsheet for 2012-13.

Technical Guidance

View the technical guidance which includes:

• step by step guide: calculating the 2012-13 National Tariff
• market forces factor technical paper.

Mental health clustering booklet for 2012-13

The mental health clustering booklet has been updated for 2012-13.

PbR Maternity Pathways

A suite of materials have been published to support the introduction of a maternity pathway system for payment, in shadow form, in 2012-13.

PbR maternity pathways package

Maternity pathway payment system in 2012-13

HRG4 2012-13 local payment grouper

The local payment grouper is available at Information Centre Casemix service payment

Information on plans for Payment by Results in 2012-13

David Flory, Deputy NHS Chief Executive, issued a letter today which provides information on plans for Payment by Results (PbR) in 2012-13. These plans include an expansion in the scope of PbR into areas such as adult mental health, and a further increase in the coverage of best practice tariffs. He also highlights the publication by the Department of Health of a draft of the mental health PbR guidance for 2012-13.

This draft guidance in intended for all NHS organisations providing mental health services in preparation for 2012-13 and all commissioners of mental health services, to test at an early stage whether we are giving providers and commissioners enough information to set the framework for their contractual discussions, based on the new currencies.

A final version of the PbR guidance will be published later this year.

Read David Flory’s letter

Read Payment by Results: Draft 2012-13 Mental Health Guidance

Payment by Results – road test the 2012-13 package

15 December, 2011

The Payment by Results (PbR) road test exercise provides an opportunity for the NHS to test out the new tariff, and supports the planning process. The focus of the road test is to gather comments on the draft 2012-13 PbR guidance and PbR code of conduct.

If you would like to submit feedback on the draft guidance or code of conduct, please complete the road test response proforma and return it no later than Friday 20 January 2012 to: PbRComms@dh.gsi.gov.uk

Read the covering letter from David Flory

The payment by results 2012-13 road test package include draft payment by results guidance, draft payment by results code of conduct, the PbR 2012-13 tariff information spreadsheet and best practice tariff slides

Download the HRG4 2012-13 road test grouper

Guide to payment by results

1 August, 2011

The updated version of ‘A simple guide to Payment by Results’ provides an introduction for those who are new to the concept of Payment by Results.  It reflects changes to Payment by Results arrangements for 2011/12.

See A simple guide to Payment by Results

NHS Standard Contract 2012/13 available

23 December, 2011

The NHS Standard Contract for 2012/13 is published today and brings together the previous four core contracts into a single restructured contract.

The contract is for use by commissioners when commissioning NHS funded acute, ambulance, community and mental health and learning disability services from all types of providers.

The NHS Standard Contract for 2012/13 reflects the requirements set out in the 2012/13 NHS operating framework. Associated supporting guidance and national variation documents will be issued to vary the existing standard contracts that expire after 31 March 2012.

This contract sits alongside the Care Homes Contract and the High Secure Services contract which were published in 2011/12.

Commissioning for Quality and Innovation

Current  guidance on Commissioning for Quality and Innovation (CQUIN)  is available on  using the CQUIN payment framework page, including details of the two existing national CQUIN goals.  Additional guidance is included  in the 2012/13 NHS Standard Contracts guidance.

Details of two new national CQUIN goals are published.

Previous contracts

Previously published NHS Standard Contracts are available for 2011/12.

Frequently asked questions and contact details

The most recent frequently asked questions will be published shortly. If you cannot find the answer to your specific question, you can contact the NHS Standard Contracts Team at: contractshelp@dh.gsi.gov.uk

Never events list update for 2012/13

20 January, 2012

The ‘never events’ list has been updated and published with minor amendments to two of the never event definitions. The changes are to ‘never event’ number 18, ‘Transplantation of ABO incompatible organs as a result of error’ and ‘never event’ number 23, ‘Misidentification of patients’.  The never events list for 2012/13
sets out the revised list and definitions for use in the NHS in 2012/13.

Please note that the policy framework published in February 2011 is still valid, apart from the update to the definitions in the “never events” list. The policy framework and associated equalities assessment.

The full ‘never events’ list for reference is:

1. wrong site surgery
2. wrong implant/prosthesis
3. retained foreign object post-operation
4. wrongly prepared high-risk injectable medication
5. maladministration of potassium-containing solutions
6. wrong route administration of chemotherapy
7. wrong route administration of oral/enteral treatment
8. intravenous administration of epidural medication
9. maladministration of Insulin
10. overdose of midazolam during conscious sedation
11. opioid overdose of an opioid-naïve patient
12. inappropriate administration of daily oral methotrexate
13. suicide using non-collapsible rails
14. escape of a transferred prisoner
15. falls from unrestricted windows
16. entrapment in bedrails
17. transfusion of ABO-incompatible blood components
18. transplantation of ABO-incompatible organs as a result of error
19. misplaced naso- or oro-gastric tubes
20. wrong gas administered
21. failure to monitor and respond to oxygen saturation
22. air embolism
23. misidentification of patients
24. severe scalding of patients
25. maternal death due to post partum haemorrhage after elective Caesarean section.