This site is intended for health professionals only

Get rid of the tariff

The tariff is dead. Long live the tariff, our diarist Dr Peter Weaving wants to cry out - nothing too controversial then

With each passing day and attempt to move a service into the community or change a pathway I curse the tariff system and the blocks and bad attitude it puts in my way.

I do not have a system to fund an acute trust's input into a diabetes service. I do not want my patients with diabetes seen in a hospital clinic; I want the local diabetologist to educate and support GPs and specialist nurses in the community. If a patient with diabetes is admitted to hospital we've fouled up and he should pay me.

Exactly the same applies to renal replacement therapy – dialysis is a cash cow for DGHs and a disaster for patients. I want to incentivise my nephrologists to prevent patients slipping into renal failure; not picking up the pieces once they do so.

I'm trying to implement an emergency floor model with a unified staff group drawn from different organisations – acute, primary care and out of hours. The first block is who 'bills' for the patient?

We pay £5M each year for zero day admissions – patients admitted but not overnight. I would rather see my trust shed those beds and put the money into streamlining their diagnostic pathways.

Why do we have a tariff based payment system? Historically because we needed one – the then secretary of state, Alan Milburn, was responsible for a health service with long waiting lists and hospitals with no incentive to see more patients. He recognised the need for and implemented a new payment system. In a world of 18-week maximum waits, Foundation Trusts operating as profit centres and with a rising tide of elderly people with ongoing conditions we need a fresh approach.