Excess Treatment Cost Payment Changes: An Update from NHS England and NHS Improvement and the Department of Health and Social Care

Date: 25 June 2020

Quarter 1 CCG ETC payments

Due to the disruption arising from COVID-19 as well as enhancements that we are making to the payments process, all CCG Excess Treatment Cost (ETC) payments made by Local Clinical Research Networks (LCRNs) will be suspended until at least Quarter 2 of the financial year 2020/21. Note: This includes payments to both primary and secondary care providers.

Payment approach for ETCs after 1 April 2020

For all CCG Excess Treatment Cost (ETC) payments made after 1 April 2020, research Sponsors will be asked to choose a payment model that best fits their study. The aim of selecting a payment model will be to pay the site incurring the ETCs as opposed to the recruiting site, where these are not the same site. As a result, this should reduce the administration burden for organisations that have been asked to re-route ETC payments.

For studies currently receiving ETCs, the NIHR Clinical Research Network Coordinating Centre (CRNCC) will be contacting sponsors over the next few months to explain the process and to discuss the payment options available.

For all new studies (i.e. studies for which the funding letter is issued after 31 March 2020) CRNCC will contact the Sponsor to discuss the payment model after the Sponsor has been issued a funding letter.

If an investigator revises the SoECAT during the life of the study, the payment model will also be discussed as part of the approval of the SoECAT.

If a payment model is not agreed, then payments will continue to recruitment sites, as per the existing model.

2020-21 ETC Provider Thresholds

ETC Provider Threshold values are set by NHS England and NHS Improvement (NHS E/I) prior to the commencement of the financial year. However, due to the COVID-19 pandemic, this process was delayed.

The threshold values are:

• NHS Ambulance Trusts: 0.005% of total operating income (based on the 2018/19 NHS provider accounts).
• All other NHS Trusts: 0.01% of total operating income (based on the 2018/19 NHS provider accounts), or a minimum of £10,000 a year.

Consideration is being given by NHS E/I to any adjustments that may need to be made due to the effects of the COVID-19 pandemic. Communications on this will follow.

Minimum trigger for payments to primary care providers

A minimum payment trigger for ETCs (currently £100) is applied to ETCs incurred by primary care providers. This was introduced to prevent the cost of processing ETC payments outweighing the actual value of the ETCs.

ETC payments are made to primary care providers each quarter, once the minimum payment trigger is reached. If a primary care provider does not reach their minimum payment trigger value during the year, they are reimbursed at year-end irrespective of whether the ETC payment trigger value has been reached.

A review of this minimum payment trigger took place and it was clear that the value of £100 was excessively low and that large numbers of payments for relatively low values were continuing to be made. As a result, from 1 April 2020, the minimum payment trigger for primary care providers will be increased to £500. This will be reviewed annually.

Reference: https://www.nihr.ac.uk/documents/changes-for-the-ccg-excess-treatment-cost-payment-process/25077

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