NHS Quality Strategy: patient feedback and provider payment

One in three women having a hysteroscopy without sedation report pain scores of seven or more out of ten. That figure sits in the evidence base for the renewed Women's Health Strategy, and it explains why gynaecology has been chosen as the first test case for one of the more concrete commitments in NHS England's new quality strategy for NHS-funded care in England: a trial linking part of a provider's payment to what patients say about their experience. The same document sets out parallel plans to work quality improvement expectations into community pharmacy and general practice contracts. Read together, they describe an NHS payment system starting to weigh outcomes and patient experience, alongside activity, when deciding what providers are paid.

Patient power payments in gynaecology

That trial is what NHS England calls a patient power payment. A proportion of what a Trust is paid for gynaecology services will depend on women's feedback, including on the pain management behind the one-in-three hysteroscopy figure above, with any funding withheld ring-fenced for service improvements. Announcing the trial in April, the government tied it explicitly to hysteroscopy, where women have reported being dismissed or left without adequate pain relief.

The government has confirmed that testing runs through 2026 and 2027, with recommendations on wider use feeding into the 2028/29 NHS Payment Scheme.

Best practice tariffs and the wider direction

The quality strategy places the gynaecology trial alongside a broader expansion of best practice tariffs (BPTs), describing plans for around 30 additional BPTs in the 2026/27 NHS Payment Scheme, aimed at shifting activity to less resource-intensive settings such as day case and one-stop clinics. That figure traces back to the January 2025 elective reform plan, which first committed to “up to 30” BPTs for the year.

What landed in the published 2026/27 scheme was narrower: two new day case BPTs, alongside blended payment changes for urgent and emergency care, radiotherapy and genomic testing. The move toward outcome and value-linked pricing is there, but at a more modest scale.

Quality tied into pharmacy and general practice contracts

For primary care, the strategy commits to exploring how quality improvement expectations sit inside two existing contracts.

In community pharmacy, it points to embedding quality management expectations in the Community Pharmacy Contractual Framework (CPCF), alongside “the possibility of new incentives” through the Pharmacy Quality Scheme(PQS). PQS funding for 2026/27 fell to £20 million, down from £75 million in the 2022 to 2024 settlement, with fewer criteria attached. Any new incentive promised under the strategy would need to fit within that smaller pot.

In general practice, the strategy talks about embedding quality improvement and modern service framework metrics into “future GP contract reforms,” alongside the Quality and Outcomes Framework (QOF). The 2026/27 GP contract was already settled by the time the strategy was published: a 3.6% uplift, 18 new QOF points worth around £25 million, tied to updated guidance from the National Institute for Health and Care Excellence (NICE) on diabetes, obesity and childhood vaccination. It was also imposed rather than negotiated, and the British Medical Association's (BMA) GP committee began collective action at the end of April. The quality strategy's language points to the contract round after this one, arriving while NHS England's relationship with the profession is still unsettled.

This is the same commissioning landscape covered in our dispensing doctors and Single National Formulary piece: several sources of pressure on primary care contracts arriving close together, with quality expectations now added to the list.

One payment logic, multiple settings

The thread connecting gynaecology, pharmacy and general practice is the same: NHS payment is moving from rewarding activity to rewarding outcomes and experience. What differs is the pace and the certainty behind each strand.

• Gynaecology: Now has a named pilot with a stated decision point for whether to continue and extend to other therapy areas in 2028/29

• Community pharmacy: NHS England has ambition to give new incentives, but budgets for community pharmacy have just been cut rather than expanded  

• General practice: government has stated its intention to introduce patient feedback payment incentives for the next contract round, but these are not yet agreed with GP leaders, who are already contesting the current one  

What this means for pharma and medtech

For companies with products in gynaecology pathways, contraception, or chronic condition management delivered through general practice and community pharmacy, patient experience data is becoming commercially relevant for providers. Evidence generation plans and value propositions that lean on patient-reported experience, alongside clinical outcomes, will read differently to a commissioner once payment structures catch up with the strategy's intent.

There are two things to note:  

1. Whether the gynaecology trial's evaluation and the 2028/29 recommendation extend patient power payments to other specialties with similar experience concerns.  

2. Whether new CPCF or GP contract quality incentives arrive with funding attached, given the direction the PQS budget has just taken.  

Field and market access teams working close to these contracts should plan around both timelines rather than treating the quality strategy's commitments as already in effect.

Conclusion

Of the three strands, only the gynaecology trial has money attached today, and that money covers testing, not a wider rollout: the 2028/29 decision point is where funding for other specialties would be decided, not before it. Community pharmacy's quality ambition sits in a sector with a smaller budget than it had two years ago. General practice's quality ambition points at a contract round that has not yet been negotiated. For pharma and medtech companies working in these settings, the quality strategy is a statement of direction rather than a resourced programme, and the practical work is in tracking which strand gets funding behind it first, starting with whether the gynaecology pilot's 2028/29 recommendation extends beyond one specialty.

CHASE works with pharmaceutical, medtech and NHS partners on commercial strategy and NHS-Industry Partnerships across primary care and specialist pathways, including where payment reform is reshaping what commissioners expect. Get in touch to find out more.