In England, Aligned payment and incentive (API) – covers almost all NHS provider activity and comprises fixed and variable elements. Almost all elective activity is included in the variable element and paid for using 100% of NHSPS unit prices. Healthcare Resource Groups (HRGs) are the currency used to set these prices. Low volume activity (LVA) block payments apply to almost all NHS provider/commissioner relationships with an annual value below £0.5m. These are nationally set block payments based on historic activity. Where one of the above payment mechanisms don’t apply, providers and commissioners locally agree an appropriate payment approach.