We believe that aligning incentives within care systems is an essential element of successful change. SCW supports customers in negotiating and managing more than £6bn of NHS contracts across acute, community, mental health and independent sector providers.

We have developed expertise in making optimal use of the flexibilities within the NHS standard contract, along with experience of negotiating the use of aligned incentive contracts and new contracts forms, and have co-developed new contract models that align with the priorities being set within care systems.

In Portsmouth, for example, we are working with the acute providers to transition away from payment by results (PbR) contracts and embrace payment mechanisms that deliver system-wide benefits such as promoting the development of out of hospital services to treat patients closer to home, realign financial risk and promote the changing role of specialist clinicians.

Our contract management teams are supporting a number of systems to test the use of outcomes-based contracts. This approach is underpinned by the creation of a shared control total in which the organisations adopt a collaborative, rather than individual, approach to financial performance and recognise that transformational change needs to be delivered over time, rather than in a single financial performance period. This approach is helping to mitigate the financial disincentive where some organisations can be penalised by system-level change programmes under the current rules.

We are now working with customers to explore development plans for managing the transition from episode-based PbR contracts to value-based contracts over a three to five-year period.


Director of Quality and System Performance SCW Clinical Lead and Caldicott Guardian

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