Internet Explorer is no longer supported by Microsoft. To browse the NIHR site please use a modern, secure browser like Google Chrome, Mozilla Firefox, or Microsoft Edge.

Changes to the CCG Excess Treatment Cost payment process


18 June 2020


2.0 - May 2022


Update from NHS England and NHS Improvement and the Department of Health and Social Care.

Payment approach for CCG ETCs

For all CCG Excess Treatment Cost (ETC) payments, research Sponsors are asked to choose a payment model that best fits their study. The aim of selecting a payment model is to pay the site incurring the ETCs as opposed to the recruiting site, where these are not the same site.

The CRNCC will contact the Sponsor to discuss the payment model for all CCG-commissioned studies after the SoECAT has been triaged and the study record has been created on CPMS.

If a payment model is not agreed, then payments will continue to be paid to recruitment sites.

To further reduce the administrative burden, CCG ETC payments are only made twice-yearly rather than quarterly, at Q2 and Q4 of the financial year.

ETC Provider Thresholds

ETC Provider Threshold values are set by NHS England and NHS Improvement (NHS E/I) prior to the commencement of the financial year. 

As part of the UK’s Clinical Research Recovery, Resilience and Growth programme, which aims to deliver the Government’s research vision, and following discussions with partners, NHS England and NHS Improvement has significantly reduced the threshold values for NHS secondary care sites, effective from 01 April 2022. This will not only create additional funding to sites incurring CCG ETCs, it will provide funding earlier in the financial year and create stability for sites during the budgeting stages.

The 2022/23 threshold values are:

  • NHS Ambulance Trusts: 0.0005% of total operating income
  • All other NHS Trusts: 0.001% of total operating income, or a minimum of £1,000 a year.

Minimum trigger for payments to primary care providers

A minimum payment trigger for ETCs (currently £100) is applied to ETCs incurred by primary care providers. This was introduced to prevent the cost of processing ETC payments outweighing the actual value of the ETCs.

ETC payments will be made to primary care providers at Q2 if the minimum payment trigger is reached. If a primary care provider does not reach their minimum payment trigger value at Q2 they are reimbursed at year-end (Q4) irrespective of whether the ETC payment trigger value has been reached.