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GPs face huge QOF pay swings when formula axed

By Lilian Anekwe

Some practices will lose up to £100,000 a year in funding when the controversial square root formula for QOF pay is scrapped as part of a major overhaul of the GMS contract, Pulse can reveal.

The agreement to move to a pay-per-QOF-point formula based on true prevalence over the next two years will see a massive redistribution of QOF cash aimed at ensuring that income better reflects practice workload.

GPC figures obtained by Pulse show practices in deprived areas and those with many elderly patients on their lists will benefit by up to £70,000 per year – while larger practices in leafy areas with low disease prevalence rates will be the big losers.

The BMA and NHS Employers have agreed to leave it to PCTs to decide how to support the worst-affected practices, which the Government claims have been overpaid since the advent of the QOF.

The revelations came this week as the 92% of practices that are reliant on the MPIG waited nervously for more details of Alan Johnson's pledge to give them a ‘soft landing' from the phase-out of the correction factor.

No such cushion applies to the scrapping of the square root formula, which will be wound down over two years (see box).

GPC chair Dr Laurence Buckman told Pulse: ‘We know that across the UK, after both adjustments have been made, there will be a small number of practices who may lose in the region of £100,000. We do not know their exact number as this will depend on their QOF scores in the year when the adjustments occur.'

He added: ‘At the other end of the scale a handful of practices are likely to gain £70,000.'

GP negotiator Dr David Bailey, who led talks for the GPC on the future of the square root formula, said there would be a 50/50 split between winners and losers, with the average practice standing to gain or lose around £10,000 – although practices at the extremes of prevalence would see much bigger changes in income.

Dr Adam Pringle, a GP in Telford, Shropshire, whose back-of-the-envelope calculations estimate his practice will lose £60,000 a year in funding as a result of the switch to true prevalence, said: ‘We've got a young patient list, with below average prevalence in most things. It could cost us about £20,000 per whole time partner.'

Dr Pringle agreed the square root formula was ‘a stupid thing in the first place' but he added: ‘Buggering about with it every year means we can't make a sensible business plan. The only certainty at the moment is that the Government will remove random chunks of income and add random chunks of work in an incoherent way each year.'

Other GPs are delighted to see the back of the formula. Dr Timothy Scott, a GP in Tibshelf, Derbyshire, an area with 30% higher than average disease prevalence, said it had cost his practice £83,000 over three years.

He said: ‘My only disappointment is it's going over two years – I think it should be done immediately. The GPC have put themselves in a difficult position by agreeing to it in the first place, then allowing a lot of practices with a low disease prevalence to get used to being paid for a lot that they were not doing.'

Meanwhile, health secretary Alan Johnson said five successive 2% pay awards would see the proportion of practices relying on the MPIG fall to just 25%. ‘That would be great,' he said. ‘Then we can start to do things.'

But GP negotiator Dr Peter Holden said a five-year timescale to phase out the MPIG was ‘ridiculously optimistic'.

Plans for square root formula

• From 1 April 2009 the square rooting component of the formula - intended to reduce variations between practices in pounds-per-QOF-point - will go, benefiting practices in deprived areas with high disease prevalence and hitting practices with younger patient lists and low chronic disease rates
• From 1 April 2010 the truncation element which protects practices with the lowest five per cent of prevalence and is detrimental to practices with the highest five per cent rate of prevalence is removed
• Some practices will lose up to £100,000 with others gaining up to £70,000 a year

QOF shake up will lead to huge swings in pay QOF shake up will lead to huge swings in pay

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