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BMA backs call to redraw GP funding formula to reward practices in deprived areas

The BMA has called for GPs and CCGs in deprived areas to be given enhanced payments, giving greater impetus to the GPC’s attempts to renegotiate the Carr Hill formula.

A motion calling on the BMA to negotiate for ‘enhanced deprivation element in capitation payments for clinical commissioning groups and general practitioners’ was passed at its Annual Representatives Meeting in Edinburgh today after a close vote.

This gives BMA-wide backing for the GPC’s controversial decision to look into a renegotiation of the Carr Hill formula, after it had previously shelved a review in order to create a period of stability for practices.

The motion also means that the BMA will push for NHS England to change its funding allocations for CCGs, after the NHS Commissioning Board - as it was known - rejected the idea of adopting the ‘fair shares’ funding allocation in December last year, which would have taken deprivation factors into account.

A BMA spokesperson said this motion will allow the GPC flexibility in its negoiations. He said: ‘A lot of motions aren’t designed to have specifics which mandate parts of the BMA - the BMA and negotiators have flexibility to look at how they take this forward.’

Dr Pamela Martin, a GP Lewisham, proposed the motion as she said caring for deprived populations requires extra resources when compared with affluent patients of the same age or sex.

She said: ‘We had a GP join us from south England. He just shook his head and said “I can’t believe how many unworried unwell there are here”. Caring for them takes time. And time is money. And that’s not recognised. It’s certainly not recognised in QOF, it’s not recognised in any payment systems.’

Under the current system, Lewisham GPs do not receive the resources needed to care for their population because patients are younger than average, despite being one of the most deprived boroughs.

She said: ‘In Lewisham we have to treat 200 more patients for free. Because our patients are more deprived than average, they are also younger than average. Money isn’t the only answer to health inequalities but it is an important enabler. Until this is recognised we are battling against inequalities.’

She added: ‘The unworried unwell are dying younger sooner, and their suffering continues. Doctors are burning out trying to help them.’

However, GPC professional fees and regulation subcommittee chair Dr John Canning opposed the motion.

He said he practises in Middlesbrough, which is a deprived area with a low life expectancy. But improving health inequalities are achieved through jobs and work, he said, rather than ‘fiddling the economy’ through health funding.

‘If you want to improve health inequalities, you change the economy, not the health service’ he said.

Motion in full

That this Meeting believes that caring for deprived populations requires extra resources compared with age and or sex matched affluent populations in order to reduce health inequalities, and that this should be recognised by an enhanced deprivation element in capitation payments for clinical commissioning groups and general practitioners. This Meeting calls on the BMA to negotiate such enhanced payments.

Readers' comments (6)

  • How will this impact on practices with large elderly populations, or rurality? Deprivation can't be the only source of funding weighting. And will the formula be sufficiently adaptable to meet the needs of practices at the edges of the demographic curve, where the fair shares formula simply couldn't reach?

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  • Everyone thinks they work the hardest. Practices with large numbers of elderly feel they are putting in more hours than practices with younger but more deprived patients. Add the language issues to the mix of deprivation and you have a double whammy. It will always seem unfair because we are paid per patient and not per consultation. If our practice was paid for the actual demand our patients out us under, I would be significantly richer, would work part time and be a lot less burnt out

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  • Always winners and losers however you slice the inadequate funds - but likely to be just losers as expectations rise and resources fall. Even worse the manpower crisis is starting to escalate particularly in those less pleasant areas to work.

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  • One problem is that the original true Carr-Hill formula presented by the academic himself was fair and weighted for urban problems,poverty,elderly and rurality.However when it entered the political arena it was distorted by the self-interest groups in both HMG and the BMA,both of whom had powerful lobbies that were not going to lose out.Some of the subsequent contract mess and correction factors/MPIG were caused by these political distortions bringing us partly to be where we now are.
    So perhaps here the cycle starts again.

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  • My practice is in a relatively affluent area, with a list size of 14000 but only gets paid for 12800, at £60 (yes sixty quid!) per patient per year. Do our patients, most of whom are the tax engine driving the NHS, not deserve a fairer deal than this? They book appointments and attend for them, and want to have informed discussions with us about their conditions and treatment, so we are under as much pressure as those in deprived areas with both volume and complexity of workload. We already cannot afford to provide them with extended access due to the crass inflexibility of NHS England and its trumped up 30mins per 1000 patient rules.

    I appreciate the problems of deprived areas, but any further cuts in funding for us will close our doors, leaving 14000 taxpaying patients looking for a home. I expect most of them will end up in the new health centres that were built all over town in guess where - the deprived areas!

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  • 7.56 above. I agree wholeheartedly with you. I have worked in a very deprived area and am now in a practice with the same list size (6000) but in an area with low deprivation, where I work just as hard. The only difference is that the practice of 6000 in the deprived area was paid for a weighted list of 9000 patients!! While my current practice is funded for just 5,500. Surely this can't be fair? All practices are now completely overwhelmed with workload and I am not sure that there is an alternative that is fair and acceptable for all, but I feel that the situation I have described above is wrong.

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