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Practices with poor ratings and referral rates to be prioritised for £10m fund

Practices given poor CQC ratings or found to have higher-than-average referrals and prescribing ratings will be prioritised for a £10m support fund, NHS England has announced today.

The beneficiaries of the ‘turnaround’ fund – pledged as part of health secretary Jeremy Hunt’s ‘new deal’- will have to be identified by NHS England by 28 January 2016, NHS England director of commissioning Rosamond Roughton said.

In an update sent to CCGs today, Ms Roughton said practices found to have issues by the CQC will be prioritised for funding, but it does allow flexibility for ‘local intelligence’ from CCGs to be used as well.

This flexibility will prioritise practices with a high ratio of patients to GPs, but it will also give funding to practices with higher-than-average referral and prescribing rates.

Practices receiving funds will have to match any investment, and the specification stipulates funding must be spent in accordance with ‘CCG plans for primary care locally’.

It was also revealed that the fund will be allocated to each area on a population basis, with practices in the north of the country receiving £2.6 million, £2.8m going to the midlands and east, £1.5m to London and £2.4m across the south (see box below).

The GPC welcomed the funding, but warned it would require practices to ‘fall in line’ with CCG plans and ‘inevitably’ mean working with other GP practices at scale.

Ms Roughton’s communication today confirmed that practices given CQC ratings of ‘inadequate’ or ‘requires improvement’ will be prioritised for funding, as revealed by Pulse.

However, she also said that CCGs could build a ‘risk matrix’ to allocate some of the funding, based on:

  • Patient safety, either through performance issues or a CQC rating of ‘inadequate’ or ‘requires improvement’.
  • The ratio of patients to whole-time- equivalent GPs, where practices are not employing other health professionals to meet demand.
  • A higher-than-average level of referrals or prescribing.
  • Organisational issues such as ‘professional isolation’, stating that ‘a singlehanded practice has less resilience than a larger practice’.

In the letter to CCGs, Ms Roughton states the fund ‘will provide support to practices under pressure ensuring patients have continued access to high quality care’.

She added: ‘GP practices will be expected to contribute matched funding on 50:50 basis as a measure of their commitment to improvement.’

The letter added that ‘funding must not be used to support… practices that fail to engage with local CCG plans for primary care’.

The chair of the GPC’s contracts and regulation subcommittee, Dr Robert Morley, told Pulse: ‘It’s definitely a step in the right direction… but the £10m is nowhere near enough when what is required to save general practice is recurrent billions, not millions.

‘I would very much have liked to see far more the emphasis in this document on supporting practices with workforce issues, and a recognition that unless they can recruit new partners, practice closure is inevitable.’

He warned that the stipulation that practices must fall into line with CCGs’ strategies ‘is inevitably going to mean working with other practices in one form or another’.

The fund was originally pledged by Jeremy Hunt in June as part of the ‘new deal’ to prevent practices closing as a result of recruitment issues and dwindling investment.

It was hailed as a victory for Pulse’s own ‘Stop Practice Closures’ campaign and came after NHS England had been accused of allowing small and single-handed practices to fail to drive its agenda for working at scale.

However Pulse later revealed that the investment was not new money, having been siphoned from the £1bn Primary Care Transformation (formerly Infrastructure) Fund.

How the £10 million support fund will be allocated by NHS England area

North Regional team

Cheshire and Merseyside

£ 399,524

Cumbria and North East

£ 463,718

Lancashire and Greater Manchester

£ 826,024

Yorkshire and the Humber

£ 916,375

Midlands & East Regional team

Central Midlands

£ 814,509

East

£ 745,752

North Midlands

£ 695,219

West Midlands

£ 562,018

London Regional team

North East London

£ 612,238

North West London

£ 339,077

South London

£ 572,863

South Regional Team

South Central

£ 664,193

South East

£ 1,049,299

South West

£ 273,007

Wessex

£ 391,182

Roughly £700,000 of the remaining investment will be retained to support the RCGP support scheme for practices in special measures, and to operate and evaluate this pilot.

Readers' comments (19)

  • 'poor CQC ratings or found to have higher than average referrals'

    Will someone produce the evidence as to the 'optimum' referral rate for a given practice with a particular demographic. I'd love to know, honestly.

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  • Peanuts...

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  • Vinci Ho

    Really this is only the 'confession' of NHSE that there is truly a GP crisis , different from what was said not so long ago, 'crisis , what crisis?'
    10 mils? Some would say better than nothing , some would say far from enough ....

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  • in southeasr and sussex the only gainers will be practices with lmc,ccg members and nhse as* lickers for only they shall fulfil the w.t.e conditions with one gp for 1400 patients. stuff those with more than that per gp as they never belonged to the 'boys' club' - so who cares!

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  • At our practice we have been working really hard to reduce our prescribing spend. We were 14% over our budget and are now 6% over our budget. Spending in the last 2 months has been less than the budget (so we would be under budget if the changes were made before the start of the year).

    That process has taken a lot of effort and time and time again we have had to manage angry patients and time consuming complaints.

    There is no prescribing incentive scheme in our area and we will not get paid for saving that money for our CCG.

    After all of that it seems that instead of being rewarded for our effort we have probably worked ourselves out of investment. Not sure it really sounds fair.

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  • not paid for. don't do it. end of story

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  • George Murgatroyd

    I would be interested to see the methodology proposed to assess referral rates. Often these are simply crude rates per 1,000 and are not risk adjusted in a robust way to take account of population and demographic variances.

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  • Couldn't the practices just give out more antibiotics to get their scores up?

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  • Yet again poor performance rewarded, it seems there is never an incentive for good performance in the NHS but money gets given for poor performance! The best example is prescribing where savings are generally given back to CCGs who then have to return it to central funding. My answer lets spend it ourselves by spending our drug budget and stop trying to save as there is no benefit to our patients by saving

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  • Leaving aside the issue of whether or not the methodology for allocating funding is either fair or sensible, this is yet another example of

    a) closing the stable door after the horse has bolted, and
    b) promising the same money multiple times for multiple ends - this was the Infrastructure Fund, then the Transformation Fund now the Struggling Practices fund- what will it be called next week?

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