This site is intended for health professionals only
Wednesday 23 May 2012
Facebook Twiter Linkedin

Rewrite of Carr-Hill formula could lead to 30% swings in practice funding

By Gareth Iacobucci | 07 Nov 2011

GPs could see swings in funding of as much as 30% under plans for radical reform of the general practice funding formula designed to divert large sums of money to deprived areas.

The Carr-Hill formula for determining GPs' income could be replaced with a new postcode-based funding system, after the Government and GPC agreed to discuss how the formula could be adjusted from 2013/14.

The move is being explored in line with the Liberal Democrat manifesto pledge for GPs to receive more funding for working in practices treating patients from the most deprived areas via a so-called ‘patient premium'.

The GPC said it had agreed to consider giving greater weighting to deprivation factors that could see money diverted to more deprived areas, but warned that any changes would need ‘very careful' modelling.

The Lib Dem plans are aligned to the findings of a 2009 report by the think tank Policy Exchange, which called for premiums to be paid for GPs in a bid to encourage them to work in areas with high deprivation, and for practices to be paid according to the age and postcode of their patients, broken down to as small an area as 15 homes.

If progressed along these lines, the move could invoke funding swings of more than 30% if resources are shifted from the most ‘over-funded' to the most ‘under-funded' areas.

In a letter to GPs, GPC chair Dr Laurence Buckman wrote: ‘We have agreed in principle to explore how the Carr-Hill formula might be adjusted from 2013/14 onwards to give greater weighting to deprivation factors. Such work will refer to the Formula Review Group recommendations from 2007 and Professor Roy Carr-Hill's original work in 2001-03.'

GPC deputy chair Dr Richard Vautrey said the plans were currently at ‘at the exploratory stage', but would form a part of next year's contract negotiations.

Dr Vautrey said: ‘It's an aspiration that was highlighted in the Lib Dem manifesto to try and have a patient premium for patients within deprived areas. It's very much an open discussion at this point to see if there is any scope to look at the formula, and see if it is appropriately weighted for patients in deprived areas.

But he warned: ‘What we would have to do is model any potential options because you may well try to achieve one outcome that could lead to lots of unintended consequences.'

What is the Carr-Hill formula?

READERS' COMMENTS

Daryl Mullen, GP Partner,
07 Nov 2011
So long as they also factor in age and disease burden ie prevalance.
The elderly rich need just as much looking after medically as the elderly poor.
Average (5Votes)
Top
Susan Kearsey, GP Partner,
07 Nov 2011
Our 2-doctor practice has suffered a 20% reduction in our income this year due to the double effects of the reduction in PMS payments and the Carr-Hill formula. Despite growing in size by 4.7% last year, we are struggling to manage financially. We practice in the leafy suburbs of Surrey, and would suffer yet another blow to the practice finances should we incur another reduction in income as your article suggests. This would be the death knell for us and several other local practices.
Average (3Votes)
Top
Anonymous, GP Partner,
07 Nov 2011
I have am practising in an area of high deprivation & of high precentage of ethnic minorities.It is high time that the Carrhill formula is looked at again & the challenges faced by clinicians in dealing with the above two are given their due weightage & consideration.
Average (5Votes)
Top
Anonymous, Practice Manager,
07 Nov 2011
Is this really about and attempt to redistribute resources, or could it be a means to reduce overall spending? You know: rob from the rich, but don't give it all to the poor.
Average (4Votes)
Top
Simon Ruffle, GP Partner,
07 Nov 2011
Dr Kearsey and Dr Anonymous epitomize the problem-we all feel we're busy, doing our best for our community and with expenses rising and income falling are beginning to feel more undervalued as professionals (if not income.) No doubt both areas have their own unique set of issues. Affluence breeds attendence in my experience, but extra resource is required to cope with deprivation and its special requirement. A re-jig of Benny-Hill may be catastrophic for some practices. It is, I believe, harder to acheive QoF in deprived areas, so surely a deprivation added value payment in deprived areas where QoF targets are acheived would reward the extra effort without reducing funding elsewhere. (Needs pot of extra money, so scratch that idea)
Average (3Votes)
Top
Ewen Sim, GP Partner,
07 Nov 2011
There are fewer elderly poor than elderly rich, for obvious reasons, go figure...
Average (4Votes)
Top
John Ashcroft, GP Partner,
07 Nov 2011
Long overdue!
Deprivation isnt a factor in the Carr-Hill Formula. The simple reason is that Car-Hill measured the time that patients spent with the doctor in consultation, and as deprived areas were and are underdoctored he didnt find fing a weighting for deprivation... but he wouldnt would he, they were underdoctored and got what was available.
Carr-Hill recognised this, and also recognised that what he had measured did not measure the difference that more primary care could make to reducing deprivation.
This is also recognised by RAWP (Resource allocation working party) and there is a fiddle factor put into the funding of PCT for this, but PCTs dont pass on the funding they receive.
Average (1Vote)
Top
Anonymous, GP,
07 Nov 2011
The review in 2007 found that the following effects.

1) workload adjustment (comprising age-sex bands, newly registered/temporary patients
2) and an index of multiple deprivation) (as per Qresearch) supplemented by
3) consultation length and home visit adjustment
4) staff market forces factor (MFF) adjustment
5) cost of recruitment and retention (CORR) adjustment
6) ‘Cost of Unavoidable Smallness’ (CUS) adjustment
7) rurality adjustment (possibly)

Of course much water has passed since 2007
Link - http://www.lmc.org.uk/uploads/files/news/gsfaqfeb07.pdf

Unfortunately the NHS choices comparison on feedback does not distinguish between PMS/GMS/APMS and deprived/affluent practices. So ideally there should be a single contract "GMS-reloaded" with an appropriate weighting as per the GMS review commitee recommendations with a parachute effect for some like MPIG which can be phased out over time.
Average (1Vote)
Top
Anonymous, GP Partner,
07 Nov 2011
Is it just me or does any one think this translates to "further budget cuts for GPs"?
Average (2Votes)
Top
clive Henderson, GP Partner,
07 Nov 2011
CONSIDER THE FACT THAT AREAS OF DEPRIVATION OFTEN CONTAIN PEOPLE WHO HAVE A DIFFERENT ATTITUDE TO HEALTH SEEKING BEHAVIOUR. LESS LIKEY TO WANT TO UTILISE PREVENTATIVE MEDICINE. ALSO CONSIDER RURAL PRACTICES TEND TO CONTAIN ELDERLY DEMOGRAPHICS AND WHILST THIS MAY LOOK LIKE PRIVILEGE, THEY OFTEN MOVE TO SUCH AREAS AND BY VIRTUE OF THEIR AGE ARE HIGH UTILISERS OF HEALTHCARE NECESSITY, WHILST BURDENED BY REMOTENESS OF ACCESS.RURALITY IS A FORM OF SERVICE DEPRIVATION.
Average (1Vote)
Top
Anonymous, GP Partner,
07 Nov 2011
gp's do not choose if there patients are deprived. or not . people who pay taxes and fund nhs are now second class and working for them is less valuable.
cost of staff is same to gp in more or less affulent area. gp's have same financial needs.
if this policy goes ahead practices in well off area will close and government of the day will me voted out..
CAN WE HAVE ONE GOOD NEWS ONCE A YEAR AT LEAST FOR GP'S?????
Average (2Votes)
Top
Anonymous, GP Partner,
08 Nov 2011
Minor income increases to deprived area GPs may be a boost to their self worth but it is rarely enough to put additional doctor/nurse bums on seats. Constant fiddling around with Benny-Hill figures creates uncertainty in an already uncertain financial general practice world. If there is a genuine wish to improve deprived area doctoring then provide fixed doctors salaries that practices can use effectively.
Average (3Votes)
Top
Anonymous, GP Partner,
08 Nov 2011
Remember the 'Inverse Care Law'? I work close to Julian Tudor Heart's old practice in a very deprived area.Our income is well below the welsh average , we are unable to replace an outgoing partner and locums cite the busy workload as a reason why they wouldn't want a salaried or partnership.Yes we have high prevalence of the sorts of chronic disease you would expect in an economically deprived area, but we also have high consultation rates , high teenage pregnancies,high unemployment and vandalism on a regular basis.If altruism has failed to attract drs to a deprived area then a more attractive financial remuneration could be the answer .I also feel sad that the leaders of our profession have not taken a more proactive role in highlighting the medical needs of the poor and deprived areas and take steps to support the drs who work there.
Average (1Vote)
Top

ADD YOUR COMMENTS

Please note You must be a registered user of PulseToday and logged in to add comments. Opinions expressed below are those of the writers and do not necessarily reflect those of PulseToday. Comments are considered in the public domain and may be used in future Pulse coverage. We accept no responsibility, legal or otherwise, for the accuracy or the content of member comments.

Comment*

You must be logged in to add a comment.Clickhere to login.

SIGN UP FOR EMAIL NEWSLETTERS

Keep up-to-date with the latest changes to the NHS, CPD and clinical guidelines. Sign up below or find out more.

POLL

Is self-care the answer to the NHS efficiency drive? Read the full story here