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Ministers consult on split tariffs

GP leaders will tell a Government consultation that the system for health tariffs must be changed to make it easier for practices to take on services from hospitals.

The Department of Health launched a consultation on payment by results last week, which will consider reforms to the tariff system.

The GPC will suggest splitting existing tariffs into smaller parts to allow providers to take on separate elements of a service.

The 'unbundling' of tariffs would make it easier for GPs to provide services such as pre- and post-operative tests, they argue.

This would free up consultants to do more complex work and reduce NHS costs – because GPs may be able to carry out the work more cheaply.

Dr Chaand Nagpaul, chair of the GPC's commissioning service development sub-committee, said many GPs were doing this work already for no reward. 'If more tariffs are unbundled then GPs providing additional work in the community would be resourced to do it,' he said.

Dr Nagpaul said providers should be rewarded according to work quality rather than just volume: 'At the moment they call it payment by results, but it is more like payment by activity.'

Dr James Kingsland, chair of the National Association of Primary Care, said unbundling the tariff would enable tests such as endoscopies included in hospital care packages to be performed in the community at lower cost.

He said the Government should also make it harder for hospitals to claim back cash for cancelled operations.'At the moment they get about £430 when something is cancelled. That's reasonable if they cannot fill it with spare capacity, but if they are a bit busy there is an incentive just to claim the cancellation money.'

The department's consultation document is also proposing tariffs for new areas, including sexual health and community alternatives to hospital care.Health minister Andy Burnham said: 'We are committed to payment by results as a means of paying for services, but it is really important that we work with clinicians to shape services.'


• See the consultation at www.dh.gov.uk. Closing date for responses is 22 June.

Areas where tariffs may be developed

• Urgent and emergency care, including A&E, minor injury units, NHS walk-in centres, OOH • Emergency admissions• Emergency ambulance and patient transport services • Outpatient attendances where a consultant is not clinically responsible• Telephone consultations• Community-based alternatives to hospital care• Community services• Long-term conditions care• Preventive services• Sexual health services

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