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Healthcare Professionals

Reforming the Payment System

To maintain appropriate centres to achieve best quality for patients NHS England will only fund specialised services activity not reflected in contracted service lines by prior approval, and will only make payment where treatment complies with relevant published policies, and contracted datasets allow patient level validation of payment. NHS England will not make payments above national tariffs except where resulting from published national guidance.

The adoption of the new Tariff and Top up payments in 2017 represents a significant change to the revenue flows associated with specialised care, more accurately reimbursing complexity. The adoption of the new Tariff and Top up payments in 2017 represents a significant change to the revenue flows associated with specialised care, more accurately reimbursing complexity.

These amounts paid and the providers that are eligible are based on the prescribed specialised services (PSS) definitions provided by the NHS England specialised commissioning team. The list of eligible providers is contained within the PSS operational tool.  Top-up payments are only made for inpatient care.

The Identification Rules guidance document describes how specialist activity can be identified from standard and non-standard data flows. The software tool(s) supplied with the Identification Rules guidance document enable the automated identification of specialist activity from standard Inpatient and Outpatient data flows only.

The Prescribed services manual provides detailed descriptions of specialist services and the main Identification Rules guidance document attempts to describe methods of identifying activity from non-standard data flows. For a very small number of specialist services the only accurate method of identifying specialist activity is to create a local method of recording, perhaps by the creation of a local clinical registries etc.

A Simple Guide to Recording Specialised Service Activity for Dermatology has been written by the BAD to help services comply with the Implementation Rules.

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