About this document

This is the statutory consultation notice for proposed amendment to the 2025/26 NHS Payment Scheme.

The 2025/26 NHS Payment Scheme (NHSPS) has effect for the period beginning on 1 April 2025 and continues to apply during this consultation.

We are proposing to amend the 2025/26 NHSPS by changing the prices for ophthalmology services, reducing prices for some cataract services and increasing them for all other ophthalmology services. The proposed prices are set out in the Consultation annex.

The amendment would be made under Section 114E of the Health and Social Care Act 2012 (the 2012 Act).

We have considered the likely impact of the amendment and our assessment is that publication of a new edition of the NHSPS would not be required (see ‘Expected impact of the proposed amendments’).

Responding to this consultation

Proposed amendments to the 2025/26 NHSPS are subject to a statutory consultation process, as required by the 2012 Act. The statutory consultation period is 28 days, ending at midnight at the end of 6 August 2025. Please submit your feedback through the online survey.

Please contact england.pricingenquiries@nhs.net if you have any questions on the running of this consultation or the proposals.

Proposed amendment: Changing ophthalmology prices

Proposal

We propose increasing the prices for most ophthalmology services, using funding from reducing the prices for main cataract services (BZ31*, BZ32* and BZ34*). We also propose removing the price differential for complex cataracts with and without complications (BZ31A and BZ31B).

Why we are proposing this amendment

In recent years, cataract activity has been increasing faster than other ophthalmology services. In many areas, there are relatively short waiting lists for cataracts, but longer waits for other services. Analysis of NCDR SUS+ data shows the following:

• In 2017/18, 384,000 ophthalmology episodes (HRG codes BZ*) were recorded. By 2023/24, this had increased to 704,845.
• Cataract activity (BZ31*, BZ32* and BZ34*) was a significant part of this, increasing from 224,204 in 2017/18 to 456,306 in 2023/24.
• This means that, as a proportion of all of ophthalmology activity, BZ31*, BZ32* and BZ34* increased from 58% in 2017/18 to 65% in 2023/24.

This growth in activity has meant more resources going into cataracts, resulting in fewer resources for other services, including those with longer waits.

We want to encourage delivery of a broader variety of clinically necessary ophthalmology services, ensuring patients receive timely treatment for a range of conditions. We are therefore proposing to reduce the prices for the main cataract procedures (BZ31*, BZ32* and BZ34*) and use that funding to increase prices for other ophthalmology activity.

To ensure that the change in ophthalmology prices is sufficient to encourage changes in the activity delivered, we propose raising all other ophthalmology prices by 15%, funded by a reduction in the main cataract prices. This is similar to the approach to ear, nose and throat (ENT) and gynaecology services in the 2025/26 NHSPS, where we increased prices by around 15% to encourage activity in these areas. The changes were broadly supported in the consultation on proposals for the 2025/26 NHSPS.

We are also proposing to set the same prices for complex cataracts with and without complications (BZ31A and BZ31B) as assessment of 2023/24 cost data found very little difference in reported costs.

Detail of the proposed amendment

In the initial 2023/25 NHSPS, some cataract prices were manually adjusted to reflect clinical feedback. In 2024/25, as an amendment to the 2023/25 NHSPS, prices for BZ34A and BZ34B were revised to reflect more recent cost data. This involved setting separate day case and ordinary elective spell prices for BZ34* and reducing the day case prices.

For 2025/26, as with almost all prices in the 2025/26 NHSPS, ophthalmology prices were calculated by updating the 2024/25 pay award prices, applying the initial 2025/26 cost uplift and efficiency factors (see Section 8 and Annex D of the 2025/26 NHSPS for details of the price calculation). This means that the 2025/26 prices reflect the amendments made for 2024/25.

In May 2025 the Government announced the 2025/26 pay awards for Agenda for Change (AfC), medical and dental, executive and senior managers (ESM) and very senior managers (VSM) staff groups, following recommendations from the respective pay review bodies. The cost uplift factor has been recalculated to reflect these awards – for details, see the 2025/26 pay award revenue guidance. This results in a cost uplift factor of 4.83% (increased from 4.15% in the initially published NHSPS). There is no change to the efficiency factor, which remains at 2%. An updated set of pay award prices was also published.

For ophthalmology services, we are now proposing the following changes to day case, elective and outpatient procedure prices:

• Reduce the prices for BZ34* by 20% and those for BZ31* and BZ32* by 16%.
• Setting the same price for complex cataracts with and without complications (BZ31A and BZ31B). While there would be an overall 16% reduction in BZ31*, the decrease would be larger for BZ31A (21%) than BZ31B (10%).
• Applying the funding made available by the cataract prices changes as a percentage uplift (15%) to all other ophthalmology HRGs.
• Update the prices for the revised CUF, described in the 2025/26 pay award: Revenue finance and contracting guidance.

The Consultation annex sets out the proposed ophthalmology prices. It is based on the pay award prices workbook (and so all prices have been calculated using the 4.83% cost uplift factor).

How the amendment would be implemented

The ophthalmology prices set out in the Consultation annex would be published in an amended 2025/26 NHSPS Annex A.

The amended prices would take effect from the date of publication of the amended NHSPS. Providers and commissioners should use the new prices for all activity after this date.

Expected impact of proposed amendment

Amendment or full edition of the NHSPS

We have assessed the potential impact of the proposed amendments against the criteria set out in the 2012 Act, for the purposes of determining whether a new edition of the NHSPS would be required.

This involved considering the proportion of ICBs and relevant providers affected by the amendments, the likely impact, whether any organisation would be disproportionately affected and if there would be any increase or decrease to prices.

The proposed amendments would affect all ICBs, and all providers of ophthalmology services. However, they would only change a small proportion of the overall number of prices set and the impact would be focused on a limited range of services.

Having considered these points, and had regard to the criteria in the 2012 Act, NHS England have decided that it is appropriate to consult on this proposal as an amendment to the NHSPS, as the proposed changes are not so wide-ranging to merit a new edition of the NHSPS.

Impact on providers and commissioners

All ICBs and providers of ophthalmology services would be directly affected by the amendments. There would also be an impact on NHS England as a commissioner of ophthalmology services.

In developing the proposals, we assessed the expected impact of the amended ophthalmology prices. To be sure that we were solely looking at the ophthalmology price changes, we undertook the analysis using the revised ophthalmology prices before they were updated for the revised CUF. We compared these prices with those in the initially published 2025/26 NHSPS. The assessment was based on both sets of prices being in effect for a full year. Were the amended prices to be used for only part of the year, the overall impact would be reduced. Also, were providers to change the mix of activity they deliver, the impact would also change.

For commissioners, while the amended prices would not be expected to lead to an overall change in spending, some commissioners would be expected to spend more, while others would spend less (depending on the casemix of ophthalmology services within their system).

Our assessment suggests that, of the 58 commissioners of ophthalmology services, 28 would spend more as a result of the changes and 30 would spend less. Of the 28 commissioners expected to spend more, 16 are central NHS England commissioners and the increased spending is likely to be related to the increase in PSS top-up payments, rather than directly to the changes in prices. Across a full year, the difference in commissioners’ spending ranges from +£3.6m to -£2.9m.

For providers, the amended prices would similarly mean some organisations receive higher payments while others would receive less. For NHS providers of ophthalmology services, our assessment suggests that five providers would experience a combined reduction of around £273k and there would be a total increase in payment of around £66m between other providers.

For independent sector providers, who deliver a higher proportion of cataract services, our assessment suggests that 20 of 33 providers would experience a combined reduction of around £64m, while 13 providers would receive a total increase of around £510k between them.

These changes in provider payments reflects the range of ophthalmology services currently being delivered.

As well as changes in amounts paid, the proposed amendments would be expected to have an impact on the amount of time patients wait for treatment. Waits for cataracts may increase in some areas, while waits for other ophthalmology services would be expected to shorten. Given the relatively short waits for simple cataract procedures, this is consistent with the policy objective of the proposed amendments.

Equality impact assessment

We have also considered the impact of the proposals on patients with protected characteristics. As with the assessment above, this focused on the changes to ophthalmology prices only, separate to the update to the CUF.

• For different age groups, the assessment suggested that there would be a slight (0.5%) decrease in payment for services for those aged 70-79 and 80-89, with corresponding increases in all other age groups. As cataract services are most commonly used by older people, they would be most affected by any increase in waiting times for cataracts.
• For gender, with the proposed prices were expected to lead to a 0.1% reduction in spending on female patients, with a corresponding increase in spending on male patients.
• For the remaining protected characteristics, the assessment did not identify any noticeable effects.

Having assessed the expected impacts and the policy objective – to increase the range of ophthalmology services being delivered – NHS England feel that the benefits of the proposed amendments outweigh the potential adverse impacts. We would monitor the impact of the amendment and consider if any changes are needed subsequently.