Consultation for the proposed 2026/27 NHS Payment Scheme is open in England

On November 17, 2025, NHS England published a draft 2026/27 NHS Payment Scheme (NHSPS) and launched a consultation. The deadline for submitting comments (via online survey) is December 16, 2025. 

The NHSPS is proposed to apply for one financial year (starting April 1, 2026). The proposals for the 2026/27 NHSPS align with the 10 Year Health Plan for England (10YHP) and are intended to support its objectives.

No major changes are proposed to the overall payment model. As in the previous year, four key payment mechanisms apply:

• Aligned payment and incentives (API) arrangements continue to apply to almost all NHS provider/commissioner relationships, comprising fixed (global budget) and variable (activity/quality-based) components. Elective care is reimbursed via variable component using HRG (DRG) tariffs. Specialist top-up payments continue to form part of the fixed payment as in 2025/26;
• Low volume activity (LVA) block payments - nationally set values. In 2026/27, it is proposed to 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, the following changes are proposed.

Blended payment model under API arrangements for certain services

• A new blended payment model will be introduced for urgent and emergency care (UEC), radiotherapy, genomic testing and reporting services, comprising a fixed payment and a variable payment for activity above or below the plan;
• Specific tariffs (unit prices) will be introduced to support blended payment models for same-day emergency care (SDEC), radiotherapy (SABR for prostate), and genomic testing services.

Best Practice Tariffs (BPT)

• Two new BPTs are proposed to support the delivery of elective activity as a day case rather than inpatient care, where clinically appropriate, and to reinforce 10YHP referral-to-treatment (RTT) priorities;
• “Day Case BPT” will include 22 HRGs. For the HRGs covered by the new BPT, the day case tariffs will be set higher than elective tariffs (non-BPT) to incentivize day case procedures. Where there is an outpatient tariff available, the day case and outpatient prices will be equalized to avoid creating a perverse incentive to move activity from outpatient to day case. HRGs included in this BPT concern ENT, dental, gastroenterology, general surgery (hernia, breast procedures), dermatology, men’s health, gynecology, and orthopedics;
• A 10YHP Referral-to-Treatment BPT is proposed for straight-to-test activities and one-stop clinic services, including: benign prostatic hyperplasia, sleep apnoea, diagnostic testing for haematuria, transnasal oesophagoscopy (TNO), lower urinary tract symptoms, unilateral hearing loss/tinnitus, and dysphagia. For all services in scope, a BPT price would apply to activity meeting BPT criteria, with a lower non-BPT price for in-scope activity that does not meet the criteria.

High Cost Device List

• No new devices are proposed for inclusion in the High Cost Device List;
• One device (Sonata) is considered for removal. Sonata does not meet the criteria for specialised commissioning under the specialised services devices programme (SSDP), as its usage and clinical application fall outside the scope of high cost, tariff-excluded devices intended for national oversight;
• The category previously titled “Radiofrequency, cryotherapy and microwave ablation probes and catheters” will be renamed to “Ablation probes and catheters for use in complex cardiac rhythm management procedures or in complex oncology procedures”.

No new products are proposed for inclusion in the MedTech Funding Mandate.

See the full details here.

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