Guidance

What is 3-part payment for urgent and emergency care?

A payment approach that has the potential to drive greater collaboration between all services within an urgent and emergency care network.

What is 3-part payment for urgent and emergency care?

Currently, the way hospitals and urgent care centres are paid for delivering urgent and emergency care (UEC) is almost entirely activity-based, whereas GPs and other providers of urgent care close to home are mostly paid through block contracts.

These conflicting payment approaches can be a barrier to these different services working together.

A 3-part payment is a single, consistent payment approach that has the potential to drive greater collaboration between all of the services within a UEC network. The 3 parts are:

A core payment

A guaranteed base payment to support capacity planning across the UEC network so providers can meet agreed access and quality standards.

A volume-based payment

A variable payment reflecting the complexity and volume of patient needs actually met.

A payment linked to outcomes and performance

A payment based on the overall performance of individual providers and the network. This rewards better co-ordination across the network, helping to drive the service changes that will deliver improvements in patient experience and outcomes.

Why payment reform is needed

The Five Year Forward View (5YFV) and Urgent and emergency care review propose a fundamental shift in the way UEC services are provided, improving out-of-hospital services so that we deliver more care closer to home and reduce hospital attendances and admissions.

The new care model for UEC services will change the way patients access and move within the urgent care system. It will require the development of UEC networks providing care co-ordinated across multiple settings. To deliver networked care models, providers and commissioners will need to begin moving to a new payment approach that supports joint working and delivery of high quality care and outcomes across these networks.

Benefits of this approach

The example 3-part payment approach for UEC has been specifically designed to support commissioners and providers to establish networks by:

  • reflecting the ‘always-on’ nature of UEC services
  • aligning incentives across the UEC network

The alignment of financial incentives can support co-ordination among organisations providing a range of UEC services and hence better enable a networked approach to delivering care.

Help us refine and improve this approach

Some local health economies have already begun to explore new payment approaches that better align incentives across different providers within the UEC network, including the three-part payment outlined in our local payment example. We’ll refine the payment example as we learn more from local health economies that implement these new models.

If you’re exploring the use of a 3-part payment or an alternative payment approach for UEC, we’d like to hear about your experiences. Email us at pricing@monitor.gov.uk.

More detail on this approach

Published 12 August 2015