The much anticipated 2025/26 Payment Scheme has now been published, and it is clear that 2025/26 needs to mark a financial reset, particularly in systems and providers that have not lived within planned allocations. Systems will have greater financial flexibility to manage constrained budgets, but organisations must reduce their cost base by at least 1% and improve productivity by at least 4%.
2025/26 NHS Payment Scheme Confirmation
- Continuation of payment for Elective activity based on volume and individual unit NHSPS prices
- The proposed elective payment limit/cap for 2025/26 has now been removed
- There will be a consultation to make amendments to the activity management provisions of the NHS Standard Contract, strengthening the role of Indicative Activity Plans
- Continuation of Non-Elective activity funded under a fixed/block payment
- Fixed contract values are currently still heavily based on emergency payments agreed under COVID measures, subsequently adjusted for inflation etc.
Why Accurately Clinically Coded Activity Data is Still Important
Ensuring good data quality is vital for effective payment arrangements. Both providers and commissioners must ensure they have confidence that the underlying clinically coded patient level data submitted is accurate, complete and fit for the purposes of payment under the NHSPS.
Financial
- The price of elective activity is determined by the clinical coding applied to each individual admission
- A focus on detailed and complete clinical documentation and clinical coding is required to ensure accurate recovery of income for the activity delivered
- This will mean Providers are paid fairly per case, and will not be incurring additional cost without the correct reimbursement
- Non-elective activity payments will continue to be under a fixed/block payment. In recent years this has been heavily based on emergency payments used during Covid-19, so may not reflect current activity levels and costs. These contract values will be required to be reviewed each year from 2025/26 Accurate and complete clinical documentation and coding is therefore required to:
- Align current and future fixed contract values with the value based on recorded coded activity and unit prices
- Demonstrate the true acuity and complexity and value of work performed, providing a strong negotiating position with ICBs for future fixed payments
- Supporting operational efficiencies and resource requirements to meet service provision
- Ensure fair benchmarking against other Trusts, and not negatively impacting future payment negotiations
Non-Financial
- Significant focus on improved productivity for 2025/26 with a target of 4% improvement. The value and volume of outputs (activity) to calculate productivity metrics use HRG4 weights to determine casemix complexity, therefore inaccurate coding will mean reduced reported productivity performance when compared to the inputs.
- Accurate coded activity data provides assurance to Boards that the data driving service provision, quality and planning purposes is of sound basis.
- If coding does not accurately capture patient complexity, Trusts may appear to have a higher-than-expected mortality rate compared to similar organisations with a similar case-mix. This could result in misleading conclusions about clinical quality and unnecessary interventions by oversight bodies, and teams making decisions based on incorrect data, leading to inappropriate quality improvement actions.
How Maxwell Stanley Can Help
Maxwell Stanley is the leading clinical coding specialist in the NHS. Our Solution ensures accurate recovery of income and clinical outcome metrics, through a targeted and automated identification of admissions with incomplete or inaccurate clinical coding and documentation. We have a team of qualified clinical coding experts who can then support the review and amendment of the clinical coding to realise the benefits identified.
