NHS payment system in England is “completely illogical,” says national director

BMJ 2014; 349 doi: (Published 19 November 2014) Cite this as: BMJ 2014;349:g6978
  1. Nigel Hawkes
  1. 1London

Payment systems in the NHS in England will have to change if urgent and emergency care are to be successfully reformed, a senior manager from NHS England told a meeting in London on 18 November. Keith Willett, national director for acute episodes of care, said that the present system was “completely illogical.”

In the current system GPs are paid on a capitation based contract, inpatient care on an activity based formula, emergency department visits on a payment by results tariff, emergency admissions on a tariff with different rules, and community services and social care on a block contract. “We’re stuck with financial allocations that don’t work,” he said. “We have to change the payment system before the money moves the way …

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