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GPs split over proposals to even out quality pay

GPC and NHS Confederation plans to use a complex formula to narrow the gap in quality pay between practices with high and low disease prevalence are set to split the profession.

The proposals, exclusively revealed by Pulse last week, will mean a cap on pay per quality point for practices with the highest rates of illness.

Practices with low disease prevalence would be brought up to a minimum level.

Many GPs have claimed the move would hit the hardest working practices and could deter GPs from moving to deprived areas.

But GP negotiators have defended the proposals, claiming the relationship between disease prevalence and GP workload is 'not linear' because all practices incur basic costs by doing the quality framework.

Dr Hamish Meldrum said at least half a dozen formulas were under consideration, and confirmed some form of correction to raw data would be used. He said: 'What we are trying to achieve is something that's fair to practices with high, average or low prevalence.'

Dr Kambiz Boomla, a GP in east London, agreed the range of quality pay had to be compressed. He said: 'It is not exactly double the work to deal with double the amount of patients.'

Dr Harry Yoxall, medical secretary of Somerset LMC, said the plans were a 'reasonable compromise' but added GPs would be concerned at the use of another formula after the debacle surrounding the Carr-Hill formula for allocating practices' global sum.

He said: 'It's going to be complicated. Our concern is that the calculating basis may not be accurate.'

Dr Jim McMorran, a GP in Coventry specialising in stroke, said the planned cap on quality pay for high prevalance practices would disincentivise GPs in deprived areas.

He said: 'GPs should be encouraged to maximise the quality of health care in the highest morbidity area and this should not be fudged by saying if you have a very high prevalence of morbidity you are capped on your income.'

Dr Mark Wood, chair of North Devon LMC, added: 'How far do you protect the lower end while not disadvantaging the higher end?'

How a suggested

formula works

Step 1 Number of patients on disease register/practice list size = practice raw disease prevalence

Step 2 Apply 5% cut-off at bottom of the range

Step 3 Find square root of each practice prevalence figure = adjusted prevalence

Step 4 Express adjusted prevalence figure of that disease as a ratio of the adjusted national average prevalence = adjusted practice disease factor (APDF)

Step 5 Calculate £ per point for the practice: apply APDF to this year's £ per point set for the average list

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