On 30 November 2017, NHS England and National Institute for Health Research (NIHR) published a joint statement that committed to 12 actions to support and apply research in the NHS. The first of these actions is to “manage excess treatment costs better” as part of our commitments to simplify NHS research processes.

A public consultation on proposals for managing excess treatment costs (ETCs) better was also launched on 30 November 2017. NHS England and partners published our response to the consultation on 4 May 2018 which outlined our plans for implementation of the new management model. View the consultation and response. The new system was introduced on 1 October 2018.

Effective from 1 April 2022 the organisational ETC threshold was lowered from  0.01% of operating budget to 0.001%. The process for receiving ETC payments remains unchanged. Please see this list of provider thresholds and more information on applying.

Ali Austin, NHS England Deputy Director for Research said: “Research provides us with the evidence of the best ways to improve care, treatment and lives of the whole population, underpinning transformation in the NHS. The majority of studies carried out in the NHS are funded by non-commercial bodies, so public sector and charities, and these studies are eligible for excess treatment costs (ETCs). The reduction in the ETC threshold will mean that more providers will receive ETC, encouraging more hospitals to take part in more non-commercial trials, helping get the best new treatments to UK patients faster”.

Excess treatment costs: Guidance on the national management model for England

This guidance was updated in September 2021 to provide the framework for how CCG commissioned studies which incur ETCs are paid and to set out the provider types which can utilise the national payment system.

The purpose of the guidance is to assist researchers navigate the ETC system.

More  information on the new model for payments is hosted on the NIHR dedicated web page

The introduction of the guidance has brought about several benefits

• A legal framework to enable CRNCC and Local Clinical Research Networks (LCRN) to manage the ETCs system.
• The creation of a single point of access to ETC management via the LCRN.
• A national pooled budget for CCG allocations managed by CRNCC on behalf of the CCGs.
• A single national system for ETCs where specialised commissioning is the responsible commissioner.
• The elimination of local variation in ETC funding arrangements for CCG commissioned studies.
• Removal of the need for researchers and providers to negotiate with commissioners.
• Increased transparency on the assessment of studies with high cost ETCs.
• Reduction in the administrative burden for providers.
• For specialised commissioning studies additional financial assurance has been created with support where necessary, and direct payments of ETCs over and above those funded within existing contracts are now provided.
• To promote consistency of costing methodology, the new Schedule of Events Cost Attribution Template (SoECAT) captures the different costs associated with clinical research to enable the generation of an average ETC per patient value for a study.

Together these improvements have brought a level of clarity, transparency and predictability to the system that previously did not exist nationwide, but there is more to be done as we listen to feedback from our stakeholders.