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Independents' Day

GP funding formula changes to be announced by autumn

NHS managers are looking at revising GP practices’ funding formula to take greater account of deprivation, they have told Pulse, with plans likely to be announced by the autumn for inclusion in next year’s contract.

NHS England has set up two groups to finally recommend changes to the Carr Hill formula, which has included representation from campaigning London practices who are pushing for the formula to take greater account of deprivation.

However, the GPC has warned NHS England to proceed with caution, as any reworking of the formula will likely have the unintended consequence of destabilising other practices instead.

This will be part of the ‘new deal’ for general practice announced by the Government last month, Pulse has learnt.

The changes to the Carr Hill formula have been under consideration since 2007, but they have never been implemented.

A review of the formula was again included in the 2014/15 GP contract agreement, but the GPC has already questioned the need for further review.

But NHS England has told Pulse that it is currently working on the formula.

A spokesperson said: ‘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.’

They added: ‘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.’

Representatives from Tower Hamlets in east London – where there has been a long-running campaign to weight practice funding towards deprived areas – are advising NHS England chief executive Simon Stevens.

NHS Tower Hamlets CCG chair Sir Sam Everington, an adviser to NHS England and a GP in Bow, told Pulse that they were consulted by NHS England on the Carr Hill formula.

He said:  ’We wanted to challenge the whole funding system in the country for primary and secondary care, because a lot of the system is based on the age of a patient.’

A team in Tower Hamlets undertook research that showed that consultation rates for a 55-year-old in a deprived area is the equivalent of a 75-year-old in a non-deprived area.

He added: ‘Now that has massive implications in terms of funding… it challenges the Carr-Hill formula.

‘Simon Stevens came to Tower Hamlets and was presented with this information and was very taken by it. That is why he asked Dr Kambiz Boomla [the GP who led the research] in particular to get involved in any new funding formulas.’

Virginia Patania, managing partner at the Jubilee Street practice and a member of NHS Tower Hamlets CCG governing board, said there had been discussions around a ‘local solution’ to the potential practice closures in the London borough as a result of the withdrawal of MPIG.

However, Miss Patania - who has been instrumental in leading the Save Our Surgeries campaign - said any agreement would be ‘an interim step until deprivation is fully acknowledged in the Carr-Hill formula, which is being revised as we speak currently’.

She said: ‘We hope that will be complete possibly by autumn and that it will have a sufficient impact to sustain general practice as of April of 2016.

‘Between now and 2016 we just really need to identify a local solution that can then be replicated by other practices across the country.’

However Dr Richard Vautrey, deputy chair of the GPC, said: ‘Since the review only just got going it is really hard to say when it will conclude. There are two groups involved and [Dr Chaand Nagpaul chair of the GPC] is involved on those from our side as well as some of our technical folk.

He said that the GPC position ‘is as it was before and has been for many years’.

Dr Vautrey added: ‘[We feel] any benefits from changing the formula were outweighed by the destabilising effect it would have on practices because of the winners and losers that it would cause and we need to bear that in mind when looking further at the formula.’

Readers' comments (36)

  • Adjusting the formula is just playing, making some winners and some losers.

    The real change should be adjusting the overall way practices are funded. Funding per appointment has to be the future.

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  • Alarm bells are ringing loudly. Re-calculation for what London wants?
    We have a huge prevalence of extremely elderly in my practice, twice the national prevalence, and they consume vast amounts of GP and nurse time and create a huge home visit list. We feel deeply aggrieved that the elderly are already badly under-represented in the Benny Hill weighting formula so that we are grossly underfunded for the work involved. Taking money off us to give to another group that is already given extra weighting will go down very very very badly indeed.

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  • As usual there will be winners and losers but there are practices in our area which have >50% of their patients with severe deprivation while some practices have less than 5%.

    HSCIC statistics shows 14.7 % of A&E attendances are from Most deprived (adjust for size of cohorts) while its 6.x % for the least deprived.
    However HSJ quotes that the least deprived patients consume 1.8% more NHS resources than the rest of the population adjusted for size).
    Go figure that!

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  • Ivan Benett

    This is good news for Manchester, of course! Most of our practices are creaking under the strain of lack of resources

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  • Bob Hodges

    Tell use where isn't Ivan......

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  • "Most of our practices are creaking under the strain of lack of resources"

    Most of the country is creaking under the strain of lack of resources!

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  • Why was a London region only included? Hmm isn't. this the Sam Etherington ex member of BMA etc

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  • Took Early Retirement

    Gosh! How I wish I hadn't retired a year ago! I really must rush to the GMC tomorrow to reactivate my registration and get a practice.

    Jam tomorrow.

    Bog te jeb'o Mr Hunt

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  • The Carr-Hill formula effectively finished my old practice. I resigned before we went down. After a stringent PMS review a practice in a relatively well off area just outside London we were only being paid for 75% of our patients. Deprived no, but very demanding with high expectations. Essentially we had just over 2000 patients who were not funded. Whatever formula is used there should be narrow standard deviations from the mean for those at either end, so that there are no horrendous losers and no massive gainers.

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  • Vinci Ho

    The bottom line is :
    Is the total amount of money going to all practices actually increased?
    Otherwise , the fallacy is they just move money around , a bit more to 'deprived' practices and a bit less to the others. The total lump sum remains the same.
    The worst scenario is a new but more 'efficient' Benny Hill formula to save even more money.
    Watch the space, mate........

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  • Azeem Majeed

    If the overall funding level remains the same and the revised formula just results in some shifts in funding between deprived and affluent areas, it's not going to address the funding problems that general practice is currently facing.

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  • I have worked in the most affluent and most deprived practice in my city. Both practices are overworked, and so are those in the middle. Some more than others though. So I hope that funding overall is increased, perhaps more so in certain practices. From what I can see it is not as simple as using deprivation or age, there are demanding patients from all walks of life.

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  • I work in one of the most affluent areas in the country. Children are brought to us after headaches lasting 30 minutes or having a temperature for an hour. They stress about how much selenium they should have in their diet and can they go to the gym if their BP has once been over 140. They present rashes and skin lesions that i cannot see with my dermoscope. Parents ring from New York after reports from the nannies at home. Nurseries insist on children being checked over for any URTI. We suffer massively from the worried well making themselves ill. Every salaried doc we've ever employed has said our surgery has been the most intense they've ever worked in. We have a 400% higher than average over 75s yet our Carr Hill factor is less than 1. When the NHS changed from being a needs led service to a demand driven one the concept of deprivation being a reliable indicator for funding went out of the window.
    There is no one formula that will work.
    Regards
    Paul C

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  • Instead of scrapping the formula, we are again juggling with the senseless formula. Leave it to NHSE and the Chairman of the LMC will have the highest deprivation followed by friends from CCGs and other NHSE cronies. Genuinely deprived Practices will be given a slightly deprived category so they shut their gobs and the merry go round will continue. We'll then wait for the next upheaval or wave of desertion from NHS.

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  • Another push to divide the profession. Revising some PMS contracts will be a start.

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  • Payment per consultation is the only way to go. How can the rest of the world be wrong?

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  • Let's first define 'Deprivation'. It's important to do so because as a Practice with almost 3 times the national average of depression, similar ratio of crime rate and high levels of unemployment - council housing and highest concentration of learning disability for a given Practice population - we are not considered a deprived Practice.

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  • Once again the NHSE winds up GPs to fight against each other whilst it sits back and watches the fun as GPs tear into themselves instead of tearing into NHSE.
    You should stand together and fight NHSE for more money in the pot instead of fighting each other for scraps from the too small pot. GPs regularly make it far too easy for NHSE to rule you.

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  • In East London we have indeed stood together to defend General Practice. This is not about what London wants it is about what General Practice needs. Lets not fight amongst ourselves for the crumbs under the table. General Practice is struggling to keep going all over the country, deprivation is one factor but there are many others. We need to unite and demand that General Practice, and in fact the NHS, is funded properly wherever we are. We made a noise in East London because that is what you have to do to get anything changed. Would be great if the rest of the country joined in and made the noise deafening. United we are much stronger, lets not make this about winners and losers.

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  • I wholeheartedly concur with the PM above.
    Gps must stop scrabbling for the tiny pot, as must Secondary Care.
    We should stand united, presenting the truth to the government.
    Why did they institue two opposing funding mechanisms in the first place ?
    Probably to make us so busy arguing we cannot present a unified argument.

    A single payment system for primary care and secondary care is the only way forward.

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