Excess treatment costs Clinical research projects often involve giving patients new treatments or changing the way that care is delivered. Sometimes treatment costs for patients who are enrolled in research are less, but often there is an excess treatment cost (ETC). For non-commercial research studies, these costs are the responsibility of the NHS and are funded through normal arrangements for commissioning patient care. In the past, researchers and funders have found it difficult to get commissioners to agree to pay these costs, although some primary care trusts have developed a transparent process for decision making. NHS England has been working with funders, the Health Research Authority, the National Institute for Health Research and Clinical Commissioning Groups to simplify the process for getting ETCs paid. They have published an action plan aiming to better support research. They are currently consulting on new ways of managing ETCs and hope to implement the changes during 2018/19.