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Q&A: Who decides how much funding GP practices receive?

As NHS England tries to change the role of the independent review body, learn more about how GP funding is determined in this helpful Q&A.

Who decides on the GP funding uplift?

Ultimately the Department of Health sets the percentage uplift, signed off by the health secretary, however it is not as simple as the DH being able to determine this on its own. Because the Treasury rather than the DH controls the public purse, the DH has, more or less, to act within the remit of any caps on public sector pay that the Treasury has set out, which for the past few years has been set a 1% after several years of frozen pay.

Where does the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) come in?

The DDRB acts as an independent advisor to Government on rates of pay for doctors and dentists, but the DDRB makes its recommendation only upon instruction by Government. Once the DDRB has been given this remit, the Department of Health, NHS England, Health Education England and the BMA are invited to make evidence submissions to the DDRB.

What - except for expenses - does the DDRB take into account when making its uplift recommendation?

The full list of factors the DDRB considers are: the need to recruit, retain and motivate doctors and dentists; regional/local variations in labour markets and their effects on the recruitment and retention of doctors and dentists; the funds available to the health departments as set out in the Government’s departmental expenditure limits; the Government’s inflation target; the overall strategy that the NHS should place patients at the heart of all it does and the mechanisms by which that is to be achieved; the economic and other evidence submitted by the government, staff and professional representatives and others; and the legal obligations on the NHS, including anti-discrimination legislation regarding age, gender, race, sexual orientation, religion and belief and disability.

When does the DDRB report?

Typically not before March.

What happens after that?

After that the DH reviews the recommendation and decides whether or not to implement it. For example for 2014/15, the DH accepted a DDRB recommendation of a 0.28% uplift, but for 2013/14 the DH rejected a recommendation for a 2.29% pay rise to cover expenses and said practices would only receive a 1.32% uplift in funding.

Readers' comments (3)

  • But if we are truly Independent, then we should be able to say what we think is fair pay for a days work.
    You cannot ask a Contractor to build a house, then add garages, swimming pools, granny flats et al and pay them the same or less.
    Well, that is what is happening and that is why any GP that joins has no idea and any GP that stays simply has to.
    But, thankfully, totally unfair and unjust systems undergo core collapse in free societies.
    That is what is happening to General Practice and I think the whole system so grossly unjust and bullying in nature that I cannot wait for the tipping point.
    Imposed Contracts, indeed!! Not one single person should have to work in one. Not ever.

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  • I would call it a 'grey decsion making body'
    Else how could you explain that a Practice of 2000 was paid 200000 pa and a Practice of 4000 paid 259000 pa ( including all qof and des les payments) under same gms contract and providing similar services.

    - that one Practice in the whole of UK has lower rent today than it had 19 years ago while other Practices in the area have almost 50-100% higher rents.

    - the Formula was built to favour big Practices and the designers of the Carr-Hill formula were heavily influenced by big Surgery owners becuase what they did not take into consideration was that though a big Practice has more QoF work corresponding to its list size but it also has corresponding manpower capability. Yet, they decided the value of Qof points would be multiples of the standard list size. The work was distributed across 5 GP so the work load was the same for a GP from a big Practice as for a GP was a single handed. However, for the QoF point the singlehanded with a list size of 2000 was given 60 pounds ( half the standard list size) while the GP of the 5 GP (10000) list size was given 240 pounds because the list size was twice the standard. And so NHS had to go bankrupt at some stage !!

    Both had a work burden of 2000 patients.

    Even today, scrapping the Formula is not possible because of shady affiliations and vested interests.

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  • So Anon (25 November 2014 4:51pm) should we all be rejoicing that the NHS is on the point of collapse?

    I'm not so sure about that (!) the GPC should have fought to save it, instead of standing idly by and letting it be destroyed on our watch. Shame on them and shame on us for letting it happen.

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