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Clustering in mental health payment by results: a critical summary for the clinician

  • David Yeomans

Mental health payment by results (PbR) is a disruptive new prospective payment system intended to replace National Health Service block contracts in England and provide a mechanism for opening up the mental health economy. Patients are allocated to one of 21 treatment clusters, each with a different price or tariff. Clinicians perform cluster allocation using the Mental Health Clustering Tool. The clustering process makes demands on clinicians' time even with support from information systems. Clustering is novel and it is unclear how it will work in practice. The process is likely to be susceptible to gaming.

Learning Objectives

Understand that the clinical process of diagnostic classification is different from the financial process of clustering categorisation.

Understand the importance of learning the clustering tool ratings definitions in order to make accurate cluster allocations.

Recognise that mental health payment by results is driving the widespread adoption of outcomes measurement.

Corresponding author
Dr David Yeomans, Hawthorn House, St Mary's Hospital, Green Hill Road, Leeds LS12 3QE, UK. Email:
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For a commentary on this article, see pp. 235–236, this issue.

For a discussion of the use of outcome measures see Lewis G, Killaspy H (2014) Getting the measure of outcomes in clinical practice. Advances in Psychiatric Treatment, 20: 165–171. Ed.

Declaration of Interest


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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
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Clustering in mental health payment by results: a critical summary for the clinician

  • David Yeomans
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