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Independents' Day

GPC discussing separate contracts for rural and atypical practices

Exclusive Practices with ’atypical’ populations - such as rural practices and those treating high numbers of homeless people - could be given their own contracts under plans being discussed by GPC and NHS England, Pulse has learnt. 

The chair of the GPC, Dr Chaand Nagpaul, told Pulse that the contracts under discussion - which could be national or local - is one option to solve problems exposed by the withdrawal of the minimum practice income guarantee and PMS premiums.

The GPC, NHS England and LMCs agreed last month that the ongoing review of the Carr-Hill Formula - which determines the basic global sum received by practices based on the demographics of their patients - will be unable to devise a formula that is fair for all practices. 

Changes to the formula have been under consideration since 2007, partly because of concerns that practices with atypical populations, or those in deprived areas, do not receive sufficient funding to support them to treat their patient demographics.

Dr Nagpaul told Pulse that these problems have been ‘masked’ by the MPIG and PMS premiums, which the Government is now withdrawing.

He added it is ’simply not possible to have a single national contract that can do justice to the specific needs of practices that have certain atypical populations’.

Dr Nagpaul said: ’So in some cases it may be possible to look at a contract designed for the needs of certain categories of practices. In other cases the atypical nature may be very specific to the practice, which would need a very particular arrangement.’

According to the GPC’s newsletter, the ’atypical’ populations under discussion at the meeting included: rural and isolated practices; practices with young populations; practices caring for homeless, drug users and nursing home patients; university practices; practices with large numbers of temporary residents; and practices with a high proportion of non-English speakers. 

However, the newsletter also made clear that the new contracts will not apply to all these groups, and NHS England will report to the Carr-Hill Formula review steering group regarding which populations could be included in that review, and which would require an alternative solution.

An NHS England spokesperson said: ’We have previously committed to reviewing the GP funding (Carr-Hill) formula and we restated this as part of the wider New Deal for general practice.

’We continue to work with the GPC on the review with the aim of adapting the formula to better reflect workload and deprivation. This work continues and we will communicate further in due course.’

Pulse has already revealed that changes to the Carr-Hill formula will not be made for the 2016/17 contract, despite previous suggestions they will be introduced next year.

Readers' comments (9)

  • What about high elderly patient numbers? I know practices with 40% over 65. Surely here the Carr Hill weighting can't address the demographic fully and they must be regarded as 'atypical'.

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  • Fragmentation of the 'NATIONAL' health service.All the ingredients for more local variation and inequalities.they should look at the inequalities in the current system and address those,before building more in.

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  • Really?
    We are currently in the process of having our PMS contracts changed to GMS
    So, will this new deal allow us to provide the same service to the deprived community under a new guise?
    Guess we could call it NEW PMS - the same thing, following millions in administrative costs, not to mention the time and despair it has cost us GPs.
    Carry on NHS

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  • So the ever atypical Practices with LMC members in Southeast will now also be deprived. Can LMCs not have a monthly meeting with local GPs to discus issues and then give a feedback to GPC what grassroots feel about decisions in the pot? Why do we have to learn everything from the press?

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  • The GPC need to put forward an alternative model for general practice based on copayments and insurance along the lines of countries such as Canada, New Zealand and Australia which have far better resourced health systems that also better serve the most needy and deprived.

    The U.K. Is bust. There is no more money available that the politicians are politically prepared to fund via taxation. A failure to do this by the BMA is a dereliction of their duties to members. The BMA is not an organisation that should be campaigning on behalf of the NHS. If the politicians and public are not prepared to fund it properly its healthcare safely it should not be the medical profession who should pay the price.

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  • Spot on anonymous registrar at12.38 !!!! The problem is this government does not want o bell the cat . It's waiting for us to walk away so that they can blamed he demise of NHS on the GP. I think most of us would walk away when our earning fall below level of salaried GP .

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  • We could have lots of separate allowances for different situations. All these would be recorded in a special loose leaf folder with a red cover, which we could call the Red Book

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  • Carrhill was supposed to address this last time. I have no more faith in the competence of negotiators this time

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  • I bought an Audi A1 and for 3 years went back and forth to the dealer that there was a software problem which their head office finally acknowledged but the dealership still refused to own up to. Only now it is clear that there was an issue of fraud with the emission filters and software which I mentioned kept flashing up on my screen.
    The same is happening with total Payment Units on Open Exeter Statements - they are constantly being ignored and HSCIC confirms this is being done manually at the local PCA level. Unfortunately, this seems to be State sponsored fraud to underpay certain Practices and NHSE Kent seems to have blessings of the PM himself.
    They'll have to agree to it someday just like Audi has but why do we have to tolerate such nuisance at all? Are NHS Fraud officials all on furlough?

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