This report includes details of a literature review of commissioner’s current and potential use of weighted financial remuneration and provides recommendations for commissioners.
There is variability in the remuneration structures and value across local authorities delivering NHS Health Checks, with authorities using the flexibility of the programme to drive innovation in how it is delivered. This project sought to review the evidence around the use of weighted remuneration for NHS Health Checks to aid commissioners in the design of their contracts to maximise impact of the NHS Health Check programme on population health and reducing health inequalities.
Weighted financial remuneration for NHS Health Checks is a payment structure which is tiered, based upon pre-agreed patient definition. For example a base payment of £20 per NHS Health Check completed by a provider, with an enhanced payment of £35 per check completed on patients from deprivation quintile 1 (most deprived).
The literature review found a small number of papers describing case studies where weighting remuneration to providers showed improvements in uptake of NHS Health Checks. Overall, the use of weighted remuneration for NHS Health Checks has weak evidence and remains largely under researched area. Results from the survey found that few local authorities are currently using weighted remuneration for NHS Health Checks, with the most common remuneration being based on payment per activity. Content collated from a series of semi-structured interviews described how weighted remuneration is used and detailed how it is adaptable to different population demographics.
The use of weighted remuneration to target NHS Health Checks has potential to have low, or potentially no, additional cost and can successfully target checks to priority groups within a population. Possible unintended consequences included practices withdrawing from contracts, unanticipated overspend and reduced total uptake, which should be considered when designing remuneration structures. The use of weighted remuneration for NHS Health Checks should be explored by commissioners to assess if it can be used effectively, and evaluated specifically in its potential to reduce health inequalities.
Recommendations for commissioners:
- Consider using weighted remuneration to incentivise providers of NHS Health Checks to prioritise individuals who are more likely to be at risk of cardiovascular disease
- Use local population data and evidence to inform design of any weighted remuneration structure
- Use procurement tools to facilitate changes to contracts
- Work collaboratively with interested stakeholders
- Support and engage with providers