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| Best Practice Tariff | |
|---|---|
| Name | Best Practice Tariff |
| Established | 2010 |
| Region | United Kingdom |
| Administered by | National Health Service |
| Type | Financial incentive |
Best Practice Tariff
The Best Practice Tariff is a United Kingdom NHS-linked financial incentive initiative designed to improve clinical care by linking payment to adherence with specified clinical standards. It aims to align reimbursement with measurable protocols to encourage compliance among hospitals and trusts across England, Scotland, Wales and Northern Ireland. The scheme has been associated with national health policy debates involving stakeholders such as the Department of Health and Social Care, NHS England, NHS Scotland, NHS Wales, and professional bodies including the Royal College of Surgeons and the Royal College of Physicians.
The programme attaches additional payment rates for care episodes meeting predefined clinical pathways, aiming to reward hospitals that follow protocols endorsed by organizations like the National Institute for Health and Care Excellence, the Care Quality Commission, the British Orthopaedic Association, and the British Geriatrics Society. It complements other NHS mechanisms such as the Payment by Results (NHS) tariff, the Clinical Commissioning Group arrangements, and initiatives from Public Health England and the Academy of Medical Royal Colleges. By specifying standards for conditions frequently seen in secondary care—orthopaedic trauma, cardiology, acute medicine—the scheme intersects with specialty guidelines from bodies like the Royal College of Anaesthetists and the British Association of Stroke Physicians.
The concept emerged amid broader reforms advanced under leadership associated with the Health and Social Care Act 2012 and contemporaneous policy shifts promoted by figures linked to the Department of Health and Social Care and NHS England. Early pilot forms drew on prior pay-for-performance models such as the Quality and Outcomes Framework and international comparators including programmes from the Centers for Medicare & Medicaid Services and the World Health Organization. Stakeholders including the Royal College of Surgeons, the British Orthopaedic Association, the British Geriatrics Society, and patient advocacy organizations shaped the clinical criteria through consultations that referenced evidence from trials published in journals like the British Medical Journal and The Lancet.
Eligibility standards are specified for particular diagnoses and care pathways and often require documentation of time-to-surgery targets, multidisciplinary assessment, geriatrician co-management, and adherence to protocols endorsed by specialty bodies. Criteria were developed in conjunction with guideline-producing organizations such as the National Institute for Health and Care Excellence and subject-matter societies including the British Orthopaedic Association, the Royal College of Physicians, and the Royal College of Nursing. Clinical measures often align with datasets maintained by registries like the National Hip Fracture Database and audit programmes run by NHS arms-length bodies such as Health Education England and the Care Quality Commission.
Administration of payments has been managed through mechanisms coordinated by NHS England and regional NHS bodies, with oversight from the Department of Health and Social Care and data inputs from electronic health record systems and national audits such as the National Hip Fracture Database and datasets used by the Care Quality Commission. Implementation required cooperation between acute hospital trusts, foundation trusts, clinical commissioning groups, and specialty teams represented by the Royal College of Surgeons and the Royal College of Physicians. Training and workforce planning to meet criteria involved organizations like Health Education England, academic partners such as the University of Oxford and the University of Cambridge, and policy forums including the King's Fund.
Evaluations have examined associations between tariff-linked compliance and outcomes such as 30-day mortality, length of stay, and readmission rates, with evidence discussed in forums hosted by the National Institute for Health and Care Excellence, the Royal College of Physicians, and research articles in journals like The Lancet and the British Medical Journal. For orthopaedic hip fracture pathways, reported improvements referenced datasets from the National Hip Fracture Database and analyses by the Royal College of Physicians and the British Geriatrics Society. Comparative policy analyses drew on international experience from programs at the Centers for Medicare & Medicaid Services and health system research from institutions such as the Institute for Fiscal Studies.
The tariff alters hospital income streams within the broader Payment by Results (NHS) framework and interacts with commissioning budgets overseen by Clinical Commissioning Groups and national allocations from the Department of Health and Social Care. Economic evaluations considered cost-effectiveness and budget impact, engaging analysts from the Institute for Fiscal Studies, health economists publishing in the Health Economics literature, and advisory input from policy think tanks such as the King's Fund and the Nuffield Trust. The scheme prompted discussions about incentivisation compared with alternatives including block contracts used by some NHS Foundation Trusts.
Critics raised concerns about unintended consequences, data gaming, administrative burden, and potential distortion of clinical priorities, with commentary from professional bodies like the British Medical Association, the Royal College of Surgeons, and patient groups. Debates in media outlets such as The Guardian and The Telegraph and analysis by think tanks including the Nuffield Trust questioned whether financial incentives produced sustainable quality improvements compared with regulatory approaches favored by the Care Quality Commission or guideline-based interventions from the National Institute for Health and Care Excellence. Legal and policy scrutiny referenced provisions in the Health and Social Care Act 2012 and procurement practices involving NHS England and regional commissioners.