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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)

  • this is good news?? but there should be outcome measures attached to it-otherwise some members in our part of the world will generate cash without investing in services,as is happening now since 2004

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  • The problem is we all have too much work with too little resource to deliver the care our patients need. In the LMC I cover 500 practices and each one works much harder than every other practice and each one has a great argument as to why their practice has the most needy patients.
    You need to look at what funding is received now - the range is far too great - some areas get over £2500 per patient whilst others get £1300 - the lowest funded areas are not where there are high levels of deprivation. We need to look at what is done with the money. Jackie A makes a good case for the circumstances her practice faces - but is one of the better funded areas of the country now.

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  • Secure environments GP

    The Tax Payers Alliance just 3 days ago published this, Coincidental? If anyone actually believes a new contract deal for GPs will help retain, recruit, improve morale and ease burnout must be living in the outer solar system !!

    Reforming GP contracts by implementing a review of the quality outcomes framework, minimum practice income guarantee, the senior factor payments and the dispensing doctors’ fees could help bring the cost of GPs down to a more affordable level.
    The OECD’s Health at a Glance 2013 report revealed that UK general practitioners are paid 3.4 times the average wage, while those in Belgium are paid just 2.3 times average earnings. By bringing English GP pay into line with Belgium’s, whose healthcare system is highly regarded, over £1 billion could be saved.
    It is anticipated that any review could not achieve the full saving in the first year but would be achieved through gradual reform until 2020–21.

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  • Yes I agree we don’t want to have a situation of big winner and big losers – I think someone did put a comment to that effect too – we want a fair formula that recognises the work of all GPs and ensures that Primary Care can survive and offer a quality service across the country. We want the workload that goes with deprived populations whether city or rural where life expectancy is lower and hence debility starts at younger ages to be recognised as well as the obvious increased workload that goes with a higher proportion of very elderly patients in other areas not one or the other.
    We must be united and work together to preserve excellent primary care and defend our NHS

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  • Took Early Retirement

    At the risk of a flaming, I would dare to suggest that some GPs in affluent areas don't know they are born. When we used to do night visits, our norm was to be out of bed once or twice every night. (The record was 13- yes, THIRTEEN.) The rural practice down the road from where I lived, with 2/3 the list size said for them it was once a month. Moreover, they earned more, because, in recent years, it was much easier to hit targets with their relatively well and well-educated population AND they had the nice little earner of the dispensary which, according to publicly available figures, means that they earned c £10k pa each, more than a non-dispensing GMS GP.

    Then, as an urban GP you had the endless stream of social end-stage pathology that masquerades as medicine, the constant requests for GANFYDs and letter supporting people in their appeals against loss of benefits.

    So, even though retired, I would argue for a BIG change in resources. It won't happen of course.

    Flame away colleagues!

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  • This is good news for Manchester, of course! Most of our practices are creaking under the strain of lack of resources ..... says Ivan who is now pushing 7 day GP access.

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