2026/27 NHS Payment Scheme released in England

On March 26, 2026, NHS England published the NHS Payment Scheme (NHSPS) for the 2026/27 financial year (beginning April 1, 2026). The NHSPS establishes the payment mechanisms for NHS-funded care, mainly covering secondary care services such as hospitals, community services, ambulance trusts, and mental health. It does not apply to primary care (e.g., GPs, dentists, pharmacies) or public health services such as vaccination programs. 

As in the previous year, four payment mechanisms apply:

• Aligned payment and incentives (API) continue to apply to almost all NHS provider/commissioner relationships, comprising fixed (global budget), variable (activity-based) components, and newly introduced blended payments for selected services;
• Low volume activity (LVA) block payments (nationally set values) apply to almost all NHS provider/commissioner relationships with an annual value of less than £1.5m;
• Activity-based payments for services delivered by non-NHS providers using HRG tariffs;
• Local payment arrangements - the payment approach is locally determined and applies to activities not covered by another payment mechanism.

While the overall structure remains, several changes were implemented. More details are provided below. 

Fixed component of API

• Continues to function as a global budget, with the amount and scope of services agreed between the commissioner and provider. It should include services not covered by other API components (e.g., critical care, maternity care), expected achievement of ‘annual’ Best Practice Tariffs (BPTs), and specialist top-up payments (% increase of HRG tariffs for specialized services);
• Key change: Non-elective (urgent) care is no longer included in the fixed component and is instead funded through new blended payment arrangements.

New blended payments as part of API

• Apply to urgent and emergency care (UEC), including A&E, non-elective admissions with overnight stay, and same day emergency care (SDEC), as well as selected radiotherapy services and genomic testing for cancer and rare diseases;
• The key components of blended payments are fixed (calculated as NHSPS prices x planned activity) and variable (for activity different from planned);
• To support blended payments, NHSPS has published: National HRG tariffs for non-elective admissions and A&E activity, benchmark (guide) prices for SDEC activity, national tariffs for radiotherapy (unbundled HRGs for external beam radiotherapy and specialist unit prices for Stereotactic Ablative Radiotherapy), and new tariffs for genomic testing and reporting connected to Test Method Codes.

The variable component of the API 

• The variable component remains broadly unchanged and includes activity-based payments for: elective care (outpatient, day case, and hospital stay) using HRG tariffs; Community Diagnostic Centers (CDC) activity using nationally set tariffs (HRG of fee-for-service); diagnostic imaging and nuclear medicine using unbundled HRG tariffs; Actual attainment for ‘activity’ BPTs.

Best Practice Tariffs (BPT)

The two existing categories of BPTs remain: 

• Annual BPT, where the value of expected achievement is included in the API fixed element;
• Activity BPT, which now comprises two types – elective activity BPTs paid either through the API variable element or via an activity-based payment mechanism, and BPTs related to urgent and emergency care, which are incorporated into blended payments.

Two new BPTs were implemented.

• “Day Case BPT” covers 22 HRGs across specialties, including ENT, dental, gastroenterology, general surgery (hernia, breast procedures), dermatology, men’s health, gynecology, and orthopedics. This BPT sets higher tariffs for day case procedures compared to inpatient equivalents to incentivize same-day care. Where there is an outpatient tariff available, the day case and outpatient prices are equalized to avoid creating a perverse incentive to move activity from outpatient to day case.
• A Referral-to-Treatment BPT supports the 10 Year Health Plan priority to restore the standard of 92% of patients beginning treatment within 18 weeks of referral. Encourages earlier diagnosis and streamlined pathways, including one-stop clinics and straight-to-test models. BPT applies to 17 HRGs, covering areas such as benign prostatic hyperplasia, sleep apnoea, haematuria diagnostics, transnasal oesophagoscopy, hearing loss/tinnitus, and dysphagia. It provides higher tariffs for activity meeting BPT criteria, with lower payments for non-compliant activity.

High Cost Device List

Payment mechanism remains – excluded from API and subject to local payment arrangements. No new devices have been added in 2026/27. One device (Sonata system for diagnostic imaging and treatment of symptomatic uterine fibroids) was removed from the NICE special arrangements process, as it does not meet specialised services devices programme (SSDP) commissioning criteria. One category has been renamed from “Radiofrequency, cryotherapy and microwave ablation probes and catheters” to “Ablation probes and catheters for use in complex cardiac rhythm management or oncology procedures”.

MedTech Funding Mandate

No new items were added in 2026/27.

See the full details here.

This news is just one of about 300 market access news collected by our team in the premium subscription service Market Access Monitor every week from more than 80 organizations. Access our paid service to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Access is organized as an online Database and email alert formats. Contact us to get a free, three-month, no-obligation trial.