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Gold, incentives and meh

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)

  • The issue is not really the Benny Hill formula but the total envelope of funding for GP services.
    It needs to double so that the many patients I see with multiple co-morbidities that cannot be managed by guidelines and need 20 -30 minutes of GP time get the care outside hospital that they need

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  • Preaching doesn't work Jackie - you were lucky to live in an area where campaigning support was available........the definition of deprivation needs to made transparent when so many areas will scrabble to become defined as deprived - some of those who do claim that already have a mixture of affluent and poorer people on their lists. The well off certainly wouldn't like to know their posh area including in parts of previously definitely deprived now trendy London is being defined as deprived. This will only encourage more gaming.

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  • It is disappointing to see the scabbling and in-fighting for resources. We need to stand together and acknowledge primary care is underfunded. Practices like mine (The Limehouse Practice, Tower Hamlets) that are likely to close in the next 6 months due to lack of funds to manage our demand just want an even playing field with equitable services for our patients and a fair wage for a fair day's work that allows us to retain happy and health GPs.

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  • The only answer is payment per consultation and limiting the number of consultations per patient per year. Patients will have to pay after that or take out insurance policies

    This government will not inject more money in to the NHS

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  • I'm with Paul Cundy on this one. I work in a really nice area, the patients are generally great but very demanding of services. 0.44% of our population take up 3.5 sessions of GP time for nursing home visits. We have lots of 'retirement' development where affluent patients come and see us or ask for visits. We see babies at the first sniffle or loose stool! A possit onto the expensive flooring is reflux is it not?My collegues and I are working 12+hr days seeing or calling 40+ each everyday. Trying to get an appointment with us is frankly a nightmare as we're fully booked the whole time. Is money the answer- yes, more staff more money; we cannot drive demand down and cope with the existing levels when the press government charity and advances in care and age demographics continue to drive demand. First world problems heh?

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  • There is a straight forward answer for the interim problem of 2015-16 funding which is to restore MPIG until the funding formula has been worked out. The wider context is chronic underfunding of general practice, and wasted billions in the NHS by the top down 2012 H&SC Act and drive to competition.
    Stop blaming patients for being old, we are only a year old than last year, blame government cuts and privatisation

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  • Look here everyone, united we stand. We all lose as staff and patients if we don't have properly funded NHS general practice, so we must fight for an uplift overall. As hospitals shrink, (and I am not only talking about the primary care burden of the crisis at local PFIs) a whole load of work has been pushed onto us in general practice across the country and the remit of that work has increased, including long term conditions' managment, but our share of the NHS budget has dropped. We shouldn't take no for an answer from the Government.

    In addition, and I work in a practice in Tower Hamlets
    under threat of closure, there has been historic (see Collings JS 1950 in Lancet) and ongoing underfunding of general practice for some parts of the population, from students to the deprived. This is particularly the case in urban areas, where poor people are concentrated. Many have multiple problems and come more often with more illnesses, worse and experienced much younger. Deprivation weightings in the nineties improved things a bit, but we had to argue for MPIG when it became clear QOF would bring serious cuts. Meanwhile we worked to deliver high quality care and build teams, to teach, train and recruit to this work. Our efforts have been punished with QOF cuts and axing of MPIG to a level of non viability of the practice. Weighting for the elderly discriminates against areas from which well elderly emigrate and where young sick live. Each of our patients, we are told, is worth well under one person.

    General practice, and I mean the whole team, not only docs, is the very foundation of our comprehensive NHS, and to allow it to collapse in areas where it is more vulnerable, will affect everyone. It is already affecting recruitment seriously. Fair funding should allow fair access to services in relation to need and use, and fair wages and conditions for those working in it. We need to be united on this.

    Preventing closures is urgent, so in the meantime, restore MPIG.

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  • already given up hope NI GP

    Deckchairs /Titanic springs to mind

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  • I sure hope this formula takes into account language and ethnicity. Most of my patients don't even consult in English. As for those middle classed practices of worried well? My answer is to manage your population better. We had to do it with the deprived population with clear boundaries and restricted prescribing. The longer consults taken up by language issues are still a chsllenge

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  • This is indeed a chance for us to stand united as a profession- GP's, Secondary care and all the allied health professionals. I think the campaigning and unity Tower Hamlets health professionals have showed throughout can be an inspiration to us all.
    Sadly it is true it feels like we have been pitted against each other over the same pot of cash: So this is our moment. Let us defy them and ignite a new narrative! That of patient education from the MPs, not inflation of patient expectations (7 day a week access to GPs whilst also named GPs springs to mind!)
    Congratulations, Tower Hamlets.
    Rally together the rest of us!

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