Appendix 1: A toolkit to implement payment reform locally

Implementing new payment mechanisms is not straightforward. Even with requisite national approval to try different approaches, ICSs will need to take a careful approach to considering what payment mechanisms may work best for them and then plan and implement these. 

The KPMG toolkit (pages 75–78 of the report PDF) outlines an initial set of high-level practical steps that ICSs can look to begin to implement in 2024/25 on a ‘no regrets’ basis. 

Before starting, the ICS will need to ensure that it has the required skills and capacity as well as digital and analytical tools. This can practically be delivered through: 

• investing in new roles at ICS level; or 
• pooling together existing expertise and capacity from across the ICS to deliver for the whole system. 

Any locally agreed payment mechanisms during 2024/25 will need to align with the priorities in the NHS Payment Scheme 2023-25 and require national approval from NHS England using the variations request template.