PbR
Overview
Payment by results (PbR) replaces the old system of block contracts between commissioners and providers and replaces them with contracts based on predicted levels of activity.
The intention is that money follows patients through the system and thus ties in with the controversial policies of patient choice and increased competition between providers. However, implementation has not been without its problems.
Problems with PbR:
- Introduces the concept of profitable and unprofitable patient services whereby children, patients with mental health needs or co-morbidity have services reduced or withdrawn;
- Low cost private treatment centres cherry-pick low cost, uncomplicated and low risk cases and leave more high cost, complex and high risk cases to comprehensive NHS hospitals;
- NHS trusts are threatened by diverting funds to the private sector and strategic planning of health services based on need is being undermined;
- Collaboration between primary and secondary care is at risk of being eroded further not least as providers are in direct competition by pursuing incentives to treat patients;
- Bureaucracy and management costs are likely to increase significantly and the benefits of PbR are unlikely to compensate for the increased costs.
PbR should reward efficiency, promote fairness by making payments for the effectiveness of work done and offer a way of ensuring that money flows effectively within the system. The current PbR model merely provides payment for activity and does not account for results. We do not believe that PbR can work in the current severely financially capped system as it leads to excessive demand management which is likely to have a detrimental impact on patient care.
The BMA has produced a briefing document to help doctors understand the system.
The Department of Health has recently consulted on the future of PbR.
