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GPs need a long-term deal on practice funding

Rushed reform and sudden swings in income make it impossible to plan for the future

By Richard Hoey

Rushed reform and sudden swings in income make it impossible to plan for the future

Trying to untangle the finances of general practice is a bit like attempting to unravel a mass of wiring connecting up your stereo, TV, electronic hair straighteners and digital radio.

Every time you pull out a plug, convinced the device in question was doing nothing very useful, something unexpected stops working.

So it is that attempts to get rid of the MPIG, as some antique curiosity, look likely to shut down correction factor payments at a number of practices that really do need them.

Similarly, paying for QOF achievement according to flat prevalence, though much fairer than the square root formula, is going to have its fair share of undeserved casualties too, as this blog has argued before.

The big problem with reform of funding so far, though, is that it is pulling out just a few plugs, while leaving many others firmly entangled.

What, for instance, has been done so far about the global sum formula?

A joint GPC and NHS Employers task group recommended a couple of years ago that the Car-Hill formula for assigning GMS core funding needed to be replaced by a much fairer system for assessing a practice's needs and workload.

Much more recently, I've been told of an internal PCT report which claims the formula is handing out only half the cash to practices in deprived areas that it ought to be doing.

A revised formula suggested by the joint task group remains very much on the table - and if it is finally implemented practices will have to brace themselves for a new set of swings in funding.

To reform practice funding one strand at time, as the Government is doing, really does make no sense.

It leaves GPs uncertain how their practice income will look in a year's time and forced to adapt to a succession of sudden rises and falls in funding.

Surely it would have made far more sense to have negotiated a long-term pay deal rolling in reform of the square root formula, MPIG and global sum all in one.

That way, target payments for perhaps 10 years in the future could have been worked out for every practice, with gains or losses spread out to ease their impact.

Such a pay deal would have left GPs knowing exactly what kind of future they were planning for.

Instead, the Government is pulling out a couple of plugs - and risks plunging some practices into sudden darkness.

By Richard Hoey, Pulse deputy editor

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