Certain spinal procedures have been designated a top-up of 32%. The list of more complex spinal procedures and the eligible providers can be seen in the spreadsheet on the link above. The two lists were derived in 2008 to better reward spinal centres performing predominantly complex spinal work for the last year of in 2008/9. The list of Hospitals was derived without clinical input but forgotten on the introduction of HRGv4 in April 2009. The British Association of Spine Surgeons (BASS) has written to the Department of Health regarding the list of eligible providers which has resulted in a promise of closer involvement but with no solution to the issue this year. I think HRGv4 has the granularity to reflect this work and the aim will be to allocate this top-up money towards the more expensive procedures next year but within tariff so that all will benefit.