This FAQ sets out answers to key topics and questions relating to the 2026/27 NHS Payment Scheme. If you have any further questions, please contact england.pricingenquiries@nhs.net
For ease of navigation, the FAQs are grouped into overarching categories (see navigation on the left hand side of this page).
Last updated: 10 August 2026
NHS Payment Scheme – miscellaneous
Q: For activity paid on a variable basis, what data should be used for provider payments?
For activity paid on a variable basis, where reconciliation may be required, providers should be paid using quarterly freeze data. This is described in Section 46 of the technical guidance for the NHS Standard Contract.
Q: Where there is no national published price set in Annex A, how should providers and commissioners set a price
The NHS Payment Scheme contains two types of price:
- unit price: unit prices are mandated (unless a local variation is approved by NHS England) and must be used for all services within scope of an activity-based payment mechanism and for the API variable elements for elective and emergency care services.
- guide price: guide prices can be used to support local payment arrangements and as a source of benchmarking data.
Where unit prices do not exist, providers and commissioners will need to agree a local price. These can be informed by guide prices, where available, but all local prices need to follow the rules for local payment arrangements set out in Section 7 of the NHSPS. These rules require providers and commissioners to apply the payment principles set out in Section 3.1 of the NHSPS, and to have regard to the cost uplift and efficiency factors.
Q: What are the previous cost uplift and efficiency factors?
The following table sets out the cost uplift and efficiency factors since 2012/13.
National Tariff/NHS Payment Scheme cost adjustments – cost uplift and efficiency factors
| 2012/13 | 2013/14 | 2014/15 | 2015/16 | 2016/17 | 2017/18 | 2018/19 | |
| Cost uplift factor categories | |||||||
| Pay | n/a | n/a | 1.5% | n/a | 3.3% | 2.1% | 2.1% |
| Drugs | n/a | n/a | 7.2% | n/a | 4.5% | 2.8% | 2.1% |
| Capital | n/a | n/a | 3.8% | n/a | 3.1% | 3.0% | 2.9% |
| Other | n/a | n/a | 2.1% | n/a | 1.7% | 1.8% | 2.1% |
| CNST | n/a | n/a | 0.0% | n/a | 0.0% | 0.9% | 0.9% |
| Service development (acute) | n/a | n/a | 0.4% | n/a | n/a | n/a | n/a |
| Cost uplift factor | 2.2% | 2.7% | 2.5% | 1.1% | 3.0% | 2.1% | 2.1% |
| Efficiency factor | -4.0% | -4.0% | -4.0% | -3.5% | -2.0% | -2.0% | -2.0% |
| Overall cost adjustment | -1.8% | -1.3% | -1.5% | -2.4% | 1.0% | 0.1% | 0.1% |
| 2019/20 | 2020/21 | 2021/22 | 2022/23* | 2023/24* | 2024/25* | 2025/26* | |
| Cost uplift factor categories | |||||||
| Pay | 5.0% | 2.9% | 3.8% | 4.7% | 5.5% | 6.8% | 5.7% |
| Drugs | 0.6% | 0.6% | 0.6% | 0.9% | 1.3% | 0.3% | 0.8% |
| Capital | 1.8% | 1.8% | 1.9% | 5.3% | 4.0% | 0.8% | 2.4% |
| Other | 1.8% | 1.8% | 1.9% | 5.3% | 5.5% | 0.8% | 3.5% |
| CNST | -1.0% | 3.2% | 0.7% | -0.1% | 1.5% | 0.6% | 0.3% |
| Service development (acute) | n/a | n/a | n/a | n/a | n/a | n/a | n/a |
| Cost uplift factor | 3.8% | 2.5% | 3.1% | 4.7% | 5.2% | 5.0% | 4.83% |
| Efficiency factor | -1.1% | -1.1% | -1.1% | -1.1% | -1.1% | -1.1% | -2.00% |
| Overall cost adjustment | 2.7% | 1.4% | 2.0% | 3.6% | 4.1% | 3.9% | 2.83% |
| Notes: Cost uplift factor set to two decimal places from 2025/26. Calculations are done unrounded. * These figures show the cost uplift factors that were revised in-year to reflect annual pay awards, rather than the value included in the initially published National Tariff/NHS Payment Scheme. For 2022/23, the 4.7% figure reflects the change in national insurance contributions introduced in November 2022. | |||||||
Q: Should optical coherence tomography (OCT) scans be paid for separately to an outpatient ophthalmology attendance?
No – the NHSPS guidance explains that they should not be paid separately (see Annex B, Section 4)
Q: Should advice and guidance (A&G) be paid on a hosted basis, so the ICB only pays the providers inside the system or should all ICBs pay all providers for A&G?
In almost all cases, A&G should be paid on a responsible commissioner basis.
Q: How is Continuity of Carer funding reflected in maternity payments?
A: All funding for maternity services, including Continuity of Carer, should be included in the API fixed element.
Q: Are Urgent Care/Treatment Centre charges from NHS providers to ICBs covered under the LVAs?
As set out in section 5 of the NHS Payment Scheme, the LVA payment value covers all services delivered by an NHS provider for an ICB. No invoicing should take place outside of this payment, other than where the LVA rules specify particular exceptions. Urgent Care/Treatment Centre charges would not be covered by these exceptions and so should not be charged in addition to the LVA.
Please note that the LVA rules only apply where there is an LVA arrangement between provider and commissioner – see Annex A, tab 15 for details of the LVA Schedule.
Q: How do I nominate changes to the high cost drugs and devices exclusions lists?
To make a nomination, please fill out the template (available from the NHS England website) and submit it, along with all relevant supporting evidence, to: mailto: england.pricingenquiries@nhs.net.
We guarantee to review all nominations received before the end of May for the subsequent year’s Payment Scheme (eg for the 2027/28 Payment Scheme, nominations should be submitted before 31 May 2026).
OPCS 4.11
Q: How does the 2026/27 NHSPS reflect the introduction of OPCS 4.11?
A new edition (v4.11) of OPCS procedure codes was introduced on 1 April 2026. On 10 April, a pricing table of coding equivalence (TOCE) was released. This means that activity data which is coded using OPCS4.11 can continue to be processed via the HRG4+ 2025/26 Local Payment Grouper.
SUS+ is commissioning a modified 25/26 AutoGrouper that will incorporate this table. Technical requirements for the SUS+ Autogrouper require a one-to-one mapping of new and retired codes. The pricing TOCE is not the same as the coding equivalence table published in clinical coding guidance which includes mappings from 4.11 to combinations of 4.10 codes. The purpose of the pricing TOCE table is to produce Healthcare Resource Groups (HRGs) from new 4.11 codes using the 25/26 grouping logic such that these HRGs will work with the published NHS Payment Scheme prices.
Retired codes, and codes from new extended categories in OPCS-4.11, are included in the pricing TOCE. These map to a code that will ‘U group’ within the HRG4+ 2025/26 design. This was necessary to ensure that Autogrouper will ‘U group’ activity if a code that is no longer valid in the updated OPCS-4.11 classification is found.
Please contact england.pricingenquiries@nhs.net for questions relating to the pricing TOCE. For questions about HRGs and groupers, please contact enquiries@nhsdigital.nhs.uk.
Q: OPCS 4.11 coding has materially affected a procedure’s grouping. How can I manage this impact in-year with my commissioner?
For 2026/27, a pricing Table of Coding Equivalents (TOCE) is being used to accommodate OPCS 4.11 coding. This allows activity data to continue to be processed via the HRG4+ 2025/26 Local Payment Grouper. However, it has been identified that a small number of complex procedures may group to an HRG with a lower than expected price.
It may be appropriate for commissioners and providers to consider using local variations to address this issue for services including:
- Robotic assisted bronchoscopy, grouping to DZ66Z Complex Therapeutic Bronchoscopy
- Electromagnetic Navigation Bronchoscopy, grouping to DZ66Z Complex Therapeutic Bronchoscopy.
Q: Should OPCS 4.11 apply to currency grouping for a spell that discharged on 1 April 2026?
OPCS 4.11 came into effect on 1 April 2026 and applies to all episodes that complete from this date. The Who Pays? guidance, which established responsible commissioner, has clear rules about payment triggering from discharge date. This applies to the grouper in the same way as the responsible commissioner. As such, any spell that ends after 1 April (regardless of when they were admitted) should use OPCS4.11.
Please note that, for 2026/27, a pricing Table of Coding Equivalents (TOCE) is being used to accommodate OPCS 4.11 coding. This allows activity data to continue to be processed via the HRG4+ 2025/26 Local Payment Grouper.
Patient-not-present payments
Q: How should I implement patient-not-present payments
The 2026/27 NHS Payment Scheme introduced patient-not-present (PNP) payments – a mandatory unit price of £33 (plus relevant MFF) for each RTT clock stop delivered through PNP activity.
PNP activity refers to necessary clinical and administrative tasks which do not involve a face-to-face or virtual appointment. Examples include post-referral triage, validation, review of diagnostic results and setting out care plans. Much of this activity will result in the patient requiring no further intervention, stopping the RTT clock.
The published 2026/27 NHSPS stated that PNP payments should be implemented by 1 July 2026. NHS England subsequently confirmed that the payments should be implemented from 1 May 2026, with payment applying to eligible activity and PNP RTT clock stops recorded from that point onwards.
PNP reporting functionality is live within the Waiting List Minimum Data Set (WLMDS), and providers should record edibility activity. Payment will be calculated nationally, with calculated figures shared with systems quarterly for distribution to providers as appropriate. Commissioners should pay for all activity from 1 May.
All relevant activity should be paid for (not just growth above a 25/26 baseline) and funding is included in existing allocations.
The 2026/27 elective report includes PNP payment calculations from May 2026 and is published on Futures.
For more information about PNP, please see NHS Payment Scheme (Annex B, Section 3.5) and the Elective Care Futures workspace.