Best practice tariff (BPT)

Patients presenting with symptoms of stroke need to be assessed rapidly and treated in an acute stroke unit by a multidisciplinary clinical team. The team will fully assess, manage and respond to complex care needs, including planning and delivering rehabilitation from the moment the patient enters hospital to maximise their potential for recovery. The acute stroke care BPT is designed to generate improvements in clinical quality in the acute part of the patient pathway. It does so by incentivising key components of clinical practice. The aim is to reduce unexplained variation in clinical quality and spread best practice. 

BPT for acute stroke care for 2017-2019

The 2017/19 National Tariff Payment System came into effect from 1 April 2017. 

The BPT is made up of three individual conditional payment levels, where:

a. patients are admitted directly to an acute stroke unit either by the ambulance service, from A&E or via brain imaging; they must not be admitted directly to a medical assessment unit. Patients must be seen by a consultant with stroke specialist skills within 14 hours of admission*, then spend most of their stay in the acute stroke unit

b. initial brain imaging takes place within 12 hours of admission; for the purposes of the BPT, reporting times are not defined but access to skilled radiological and clinical interpretation must be available 24 hours a day, seven days a week to provide timely reporting of brain imaging**

c. patients are assessed for thrombolysis, receiving alteplase if clinically indicated in accordance with the NICE technology appraisal TA264 Alteplase for treating acute ischaemic stroke guidance on this drug. 

Amendements due to SSNAP dataset change (December 2017)

In order to harmonise the reporting of the acute BPT before and after December 2017 when changes the SSNAP dataset were introduced, SSNAP and the NHS England Best Practice Tariff team have agreed to utilise the time to stroke consultant that most closely matches the timings reported prior to the dataset change:

• For patients whose first contact (Q3.3b) is “In person” or “Telemedicine”, the time contact first made with a stroke specialist consultant will be used (Q3.3a)
• For patients whose first contact (Q3.3b) is “By telephone”, the time first assessed by stroke specialist consultant in person (Q3.3c) will be used. 

BPT for acute stroke care for 2019-2021 and onwards

SSNAP are currently seeking to amend the wording of the acute stroke BPT for patients admitted on or after 1st April 2019 to utilise the time of first contact, regardless of modality. This would allow teams to use the time of first telephone contact within 14 hours when claiming the acute stroke BPT. We will keep you updated with the progress of these agreements.

NHS 7 days working standards

SSNAP are seeking to harmonise the requirements for the acute stroke BPT with the new NHS 7 day working standards so that the time of first telephone contact within 14 hours can be utilised for both the BPT and the 7 day working standards. We will keep you updated with the progress of these agreements. 

SSNAP do not report on BPT in the regular reporting. Instead, SSNAP provide an Excel based tool to enable individual providors to export their own data and assess compliance against each BPT tool. Guidance on how to use the tool can be found here. 

More information on BPT can be found here

* For 2017/19, we have amended criterion (a) to include a requirement for patients to be seen by a consultant with stroke specialist skills within 14 hours of admission

** For 2017/19, we have amended criterion (b) to clarify requirements around reporting