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Independents' Day

Deprivation ruled out of new income formula

By Ian Cameron

The next version of the Carr-Hill allocation formula is almost certain not to contain weightings for ethnicity, deprivation or diseconomies of scale, Pulse has learned.

Work done for the review of the formula, which determines practices' global sums, has concluded the age and sex of GPs' lists account for more than 90 per cent of workload differences.

The news is a blow for GPs in urban areas and with large numbers of minority ethnic patients, who have campaigned for the revised formula to take more account of these factors.

Professor Julia Hippisley-Cox, professor of clinical epidemiology and general practice at the University of Nottingham, said the findings had been reached after modelling 'between 30 and 40' variations of the formula.

She said: 'The relationship with deprivation was not as steep as we might have expected and there tended to be lower consultation rates with high ethnicity, which may well be an access issue.'

Dr Hamish Meldrum, GPC chair, indicated the results meant there was little room to add to the formula. He said: 'If you just had age and sex it would cover 90 per cent plus of workload issues. Rurality, deprivation and ethnicity all have a much more minor impact.'

Factors such as homelessness or number of patients with English as a second language may be best met 'outwith the formula', Dr Meldrum said.

Dr Fay Wilson, secretary of Londonwide LMCs, who led a campaign against implementing the 'crude' Carr-Hill formula in 2003, said existing weightings for population density and deprivation had to be replaced.

She said: 'The GPC ­ which tends to represent middle-class, middle England GPs ­ chose not to pay attention to the urgent and pressing needs of urban, deprived areas. They are shockingly badly funded.'

Dr Justin Amery, a GP in Oxford who has franchised several deprived practices, said: 'People present with a lot more problems and they are more enmeshed. It significantly increases the length of consultations and it's much more draining.'

Dr Meldrum said the problem with the formula was not that weightings were wrong but that the Government did not put enough money into it.

The review concludes later this year, with a new formula to come into effect in April 2007.

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