The Sexual Health Tariff
The London Sexual Health programme was successful in getting £66k from the Department of Health sexual health policy team for development of the tariff work. Given the varied commissioning practices within sexual health it has been hard to gauge clarity of cost for each component of a sexual health services. Without this it has been difficult, in the past, to conduct outcomes based and cost-effective commissioning.
To tackle this, a steering group and a finance & contracting group were set up by the London Sexual Health Board. The groups have led the work since November 2009 to develop commissioning currencies (the components of care) and their associated costs (tariff).
Over 140 care pathways have been drawn up using the latest best practice and clinical standards required to deliver better health outcomes. Each component of these pathways has been costed to allow the pathway price to be calculated and the resultant set of Sexual Health Tariffs could replace the existing GUM tariff and the block contracts giving a level of detail that ensures commissioners only pay for the care given to their patients.
Using 2011/12 activity data and 2012/13 prices, the application of this new sexual health currencies and tariffs give an estimated spend for 2012/13 by PCT of £119.3 million for London. Compared against the ‘as is’ current expenditure of around £128 million, sexual health services would cost commissioners £14.8 million less using the new SH tariff; of which £8.7 million are costs for providing sexual health services to Londoners and £6.1 million to individuals living outside London. Unless there is universal application of the new SH tariff across England, the savings through recharge to out of London commissioners cannot be realised and therefore, it is more realistic to expect savings of around £8.7 million generated within London if there is universal agreement amongst all Local Authorities in London to use the SH tariff.
The financial aspect of the tariff could not go live in October 2012 as previously planned without the agreement of all 31 LAs in London; therefore, the tariff will not be fully implemented in the current financial year. The shadow tariff process has continued and services are still coding activity data and submitting it to PA.
This work has attracted a great deal of interest from commissioners within and outside London, DH policy teams, and professional bodies (British Association for Sexual Health and HIV and Faculty of Sexual and Reproductive Health) and is poised for implementation across London subject to further discussion with Local Authority colleagues who will take the responsibility for commissioning sexual health services come April 2013.