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Tariff This is the amount that a commissioner will pay for a particular package of care including out-patient appointments, spells and procedures. Commissioners now only pay for work that has been done, according to the nationally set tariff with minor local differences when a market forces factor is applied. The tariff is based on a reference cost (see above) created from a large retrospective analysis of average costs incurred by NHS hospital providers, plus an annual increase for inflation. See here. The tariff  is defined using an HRG; a currency –a spell rather than an FCE; and a cash amount.   The tariff has a different rate for children and adults, emergency and elective care, and first outpatient and follow-up outpatient appointment.  The tariff for admissions  has trimpoints; that is the length of stay up to which the tariff will be paid, and over which an excess bed day charge can be claimed but at a much lower rate. There is also work underway to “unbundle” care such as stroke rehabilitation from acute care so that it is easier to compare costs of elements that might be provided in the community. Two 2009 papers in the BMJ describe the impact of the tariff: Has payment by results affected the way that English hospitals provide care (compared to Scottish hospitals studied at the same time) doi:10.1136/bmj.b3047 and editorial doi:10.1136/bmj.b3081  The main paper concludes that there has been a reduced length of stay/increased throughput and no increased risk to patients.  However,  it is important to note the limitations of the study. Although the authors do look at readmissions, this appears to be limited to patients discharged following orthopoedic procedures and it would have been interesting to see whether medical readmission rates went up (by choosing a high volume casemix e.g. COPD). They did look at 30 day mortality which is better  than inpatient mortality although neither are particularly good at indicating whether Payment by Results has been beneficial for patients. such studies are very difficult  to do and so this has acted as a baseline and further studies might be able to reduce some of the limitations identified. In 2010/11 best practice pathway tariffs were introduced: cataracts, cholecystectomy, fragility hip fracture and a medical condition - stroke were  chosen.  For stroke, there is a base tariff and then two additional payments: one for care on an acute stroke unit (patient admitted directly to the unit)  and another for timely delivery of initial brain imaging.  For 2011/12 the two additional  payments were doubled, to create a greater differential between the base and best practice tariff.   Guidance for 2011/12 is available here.  This now includes a mandatory national currency for cystic fibrosis with local prices, and adjusted for complexity (7 bands adjusted yearly). There is no distinction between adults and children. A non-mandatory currency for smoking cessation was also introduced, following pilot work in the West Midlands.  Para 418 of the 2011/12 guidance.  Providers receive payments for both 4 and 12 week quitters, with higher payments available to those providers that support individuals from defined targeted populations such as those from deprived areas, routine and manual workers, people from black and minority ethnic groups, those with mental health issues, communication difficulties and people aged under 25. Higher payments are also paid to providers that incur the costs of stop smoking medications supplied to patients. Separate currencies and tariffs have been developed for stop smoking services delivered to pregnant women.   The West Midlands tariff ranges from 4-week quitter, general population, for providers that do not incur the costs of prescribing of £94 up to £427 for 12-week quitter, targeted population for providers that do incur the costs of prescribing. A summary of COPD tariffs using HRG4 codes (see Appendix 2 and also the BTS Guide to Respiratory Coding). Note that when the market forces factor is applied there will be minor differences, so that the local tariff may not be exactly as listed below.   Related Words  Payment by Results (PbR) Third sector The full range of non-public, not-for-profit organisations that are non-governmental and ‘value driven’;  at is, motivated by the desire to further social, environmental or cultural objectives rather than to make a profit.   Torex This is another GP computer system.  See EMIS, TPP, VAMP Vision Related Words  EMIS; TPP Total Place Total Place was launched in the 2009 Budget as an initiative  led by the Treasury to look at how a ‘whole area’ approach to public services can lead to better services at less cost. It seeks to identify and avoid overlap and duplication between organisations, look at freedoms from central control, and taking away ring-fences and bureaucratic burdens. There have been 13 pilot areas participating in the scheme, with different socio-economic and demographic profiles. Each reported in February 2010. Birmingham Bradford Coventry, Solihull and Warwickshire Croydon Dorset, Poole and Bournemouth Durham Kent Leicester and Leicestershire Lewisham Luton and Central Bedfordshire Manchester City-Region including Warrington South Tyneside, Gateshead and Sunderland Worcestershire It is being considered as an important part of the QIPP agenda in healthcare and is likely to continue despite government change. Total Place final report: Total Place: "A whole area approach to public services  63 local authorities, 34 primary care trusts, 13 police authorities and other partners, with more than 70 other local areas engaged in similar work. Together the pilots have a population of more than 11 million people and they mapped more than £82 billion of public spending in their areas."   Total Place website. Practitioner’s Guide      TPP The Phoenix Partnership, is a computer systems company working with Connecting for Health in the Midlands  to test Systmone (sic) software that shares records across primary and community care teams.  See EMIS,  Torex, VAMP Vision. Related Words  EMIS; Torex; VAMP Vision Trimpoints These are the length of stay up to which an individual tariff applies. They are spell not FCE-based and, like the tariff itself, are calculated from a large retrospective analysis of average length of stays for particular HRGs. There are separate trimpoints for elective and non-elective activity and some non-elective activity is divided into subgroups according to complexity but this is not very sophisticated at present. Trimpoints can provide a perverse incentive for PCTs to reduce the efforts they have previously been making to reduce lengths of stay because they pay the same tariff if a person with COPD without complications stays in hospital 3 days or 16 days. However, from an acute provider’s perspective, their costs relative to the price paid increase each day the patient stays unnecessarily. See here.   TUPE Transfer of Undertakings (Protection of Employment) Regulations (2006).  Designed to protect the rights of employees in a transfer situation (when a new employer takes over).  Further information in this complex area: Chartered Institute of Professional Development (CIPD), and The Statutory Instrument