Payment Scheme for Dermatology

The 2022 Health and Care Act replaces the National Tariff Payment System with the NHS Payment Scheme (NHSPS). The NHSPS contains rules to establish the amount payable for NHS-funded secondary healthcare.

The 2023/25 NHSPS came into effect from 1 April 2023.

• 2023/25 NHS Payment Scheme: 2023/24 prices workbook

There are separate prices for first and follow-up attendances, for the Adult Dermatology (330) and paediatric dermatology (257) TFC, as well as for single professional and multi-professional clinics. For patients with multiple distinct pre-booked outpatient attendances on the same day (e.g. one first attendance in the morning and a second separate follow up attendance in the afternoon) each attendance is counted separately and will attract a separate national price unless a local pathway price has been agreed with commissioners.

The tariffs for 2021-22 were designed to over-reimburse first attendances and under-reimburse corresponding follow up attendances. While this approach may incentivise less follow ups in other specialities this approach is not financially viable for dermatology departments. It is important for departments to record all procedures and treatments including dermatoscopy (S605) at follow up regardless of existing block contracts.

Departments are also advised to record all photodynamic therapy (JC46Z, JC47A and JC47B) treatments as day cases to cover the cost of treatment due to an oversight by NHS England in its tariff pricing.

For some procedures undertaken in an outpatient setting, there are national prices based on HRGs. If more than one procedure is undertaken in a single outpatient attendance, only one price is applicable.

Outpatient attendances do not have to take place on hospital premises. Therefore consultant-led outreach clinics held in a GP practice or a children’s centre should be eligible for the national price. For these clinics, it is important to make sure the data flows into SUS+ to support payment for this activity.

There are separate HRGs for face-to-face and non-face-to-face attendances, derived from the information recorded in “First attendance”.

Non-face-to-face attendances are described as “telephone or telemedicine” consultations. Telemedicine is the use of telecommunication and information technology for the purpose of providing remote health assessments and therapeutic interventions. This could include video or voice messaging services on mobile phones, computers and tablets.

The 2020/21 National Tariff set non-mandatory prices for non-face-to-face outpatient attendances, based on a subset of activity reported in 2016/17 reference costs. However, these prices were not published after 2021/22 due to:

• the wider adoption of non-face-to-face services due to COVID-19 meaning the prices may not be representative of current activity
• the wider adoption of non-face-to-face services due to COVID-19 meaning the prices may not be representative of current activity

Where local agreement on prices for non-face-to-face activity is not possible, the 2020/21 non-mandatory prices should be used.11 A non-mandatory price of £23 for non-face-to-face outpatient attendances was included in previous tariffs. However, this price was removed in the 2017/19 National Tariff and should not be used for any payment mechanism in the NHSPS.

Advice and guidance and specialist advice services are different to non-face to face outpatient activities and reimbursement for these should be agreed as part of the API agreement. This asks providers and commissioners to agree a fixed payment to deliver an agreed level of service, with a locally agreed variable payment for use if demand on the service is higher or lower than expected. For example, a teledermatology service which reviews dermatology images prior to an outpatient referral being generated should be reimbursed in this way.

Coding Standards

The Science of Casemix

The Clinical Services Unit has produced a guide to Dermatology coding in conjunction with the Expert Working Group (EWG) and NHS Digital with the aim to consolidate codes used in Dermatology departments.

The following booklet should be read in conjunction with The Science of Casemix, which is a general guide to the work of the National Casemix Office, its context within the health service, casemix methodology and the development and design of Healthcare Resource Groups (HRGs). This is available from the National Casemix Office website.