It is currently consulting on the future of Payment by Results (PbR) – the system where hospitals are paid for the work they do – but has avoided recommending a national tariff for out-of-hours and community services. Proposals outlined in the DoH’s consultation document on the future of PbR recommend developing ‘locally determined currencies’ for both areas instead.
According to the document, the cost of out of hours varies significantly despite national standards and reflects a number of issues including varying local GP costs and a wide variety of service models.
‘These are important reasons why we have not attempted to apply the national tariff to primary care and the same argument may hold for out of hours,’ the document said.
Community services, such as health visitors, district nursing and home-based intermediate care, should also be commissioned using local currencies and prices, it said. However, the document said some preventive services had the potential for moving toward a national tariff. These included smoking cessation services, which have clearly defined activity and measurable outcomes.
Nurses have argued that setting individual prices on areas such as health visitor or district nurse visits would be helpful for nurses setting up social enterprise schemes.
But Dr Laurence Buckman, deputy chair of the BMA GP Committee has claimed primary care is too complex to be able to be priced.
The DoH has also postponed plans set out in Our Health, Our Care, Our Say to introduce a single tariff for similar attendances in A&E, minor injuries units, urgent care centres and walk-in centres.
At present, PbR only applies to A&E and minor injuries units. The DoH wants to further analyse activities in these areas before extending PbR to urgent care and walk-in centres. The earliest this could happen would be 2010/11, it said.