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Gold, incentives and meh

Global sum overhaul 'profoundly flawed'

Fundamental flaws in the planned overhaul of the global sum formula will see many needy practices suffer big cash losses, the RCGP is warning.

The proposed changes to the Carr-Hill formula are designed to direct cash at the most underfunded practices, but the college believes they will fail to redistribute cash fairly.

Its scathing response to the official consultation on the formula raises fears of a repeat of Black Wednesday, when thousands of practices realised they faced unsustainable losses under Carr-Hill.

The RCGP warned the proposed formula – which would see some practices lose up to 19% of global sum income and others gain up to 31% – would hit practices with moderate levels of deprivation hardest. It would benefit those with high levels of deprivation, but only 'by accident rather than design'.

The college's key criticism is that the formula, developed jointly by NHS Employers and the GPC, places far too much emphasis on allocating funding by existing GP consultations, rather than on healthcare needs.

It says this will benefit practices with large numbers of middle-class patients, who tend to be high consulters, and 'inefficient practices' ahead of those delivering good-quality care in fewer consultations.

The college criticised the decision not to take into account nursing homes, foreign language speakers and chronic disease rates.

Dr Maureen Baker, honorary secretary of council for the RCGP, said: 'The fundamental tenet of this review is to create a formula that provides resources for the existing workload. This risks perpetuating existing unfairness in allocation.'

Dr Baker said the formula failed to take into account the fact that deprived practices were forced to 'ration' consultations, while ethnic minority patients were low consulters despite high disease rates.

The college's criticism comes amid continuing concern over the parallel review of the MPIG, which looks set to offer no protection for GPs who lose under the formula, and may claw back cash from those who gain.

Dr Stewart Kay, chair of Southwark LMC, said: 'I don't think the profession will accept 'Carr Hill mark 2' unless it has been modelled on every practice in the UK, so we can see how it will affect us and our colleagues.

'There is a big risk we could repeat the disaster of 2003. The omission of patients who do not have English as their first language is a huge issue.'

But Dr Laurence Buckman, deputy chair of the GPC, said the BMA and NHS Employers had researched health needs and found age and gender were the key determinants rather than deprivation. 'I can understand why some doctors would be surprised about that, but that's the evidence,' he said.

NHS Employers refused to comment, but said meetings were scheduled with the GPC within two weeks to discuss the consultation

How proposed formula falls short

• Health need and deprivation better indicators than current workload

• Formula does not include work for revalidation and organisation of practices

• Practices with moderate levels of deprivation will lose out

• Measures of chronic illness, nursing homes and patients speaking foreign languages, mistakenly omitted from formula

A GP's fears

Dr Richard Loh fears he could lose up to 10% of his global sum income through the twin reviews on the allocation formula and the MPIG.

The future of nurse-run diabetes and heart disease services at his practice hangs in the balance.

'Our accountants have told us we could lose money so we are just waiting here with our fingers crossed,' said Dr Loh, who works in Halifax.

The area has asylum seekers with extensive healthcare needs and a large Pakistani population with high diabetes rates.

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