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Independents' Day

Government to press ahead with ‘destablising’ Carr-Hill formula changes

Government plans to weight practice funding to give GPs in deprived areas more resources are ‘unevidenced’ and risk destabilising general practice, says the GPC.

In a letter to BMA members, GPC chair Dr Laurence Buckman revealed the Government is seeking to press ahead with altering the Carr-Hill formula to give greater weight to deprivation factors.

But he claimed there was a ‘paucity’ of data to recommend such a fundamental change to the distribution of practice funding.

The GPC had initially agreed ‘in principle’ earlier this year to look at formula changes as part of next year’s contract,  but announced in August that it had decided against any change at this time.

The Government looks set to press ahead with the changes despite GPC opposition, alongside abolishing the MPIG, raising QOF thresholds and ensuring ‘appropriate weighting for demographic factors that affect relative patient needs and practice workload’.

Dr Laurence Buckman said BMA analysts had found a lack of evidence on which to base such allocation decisions and not enough evidence to prove a link between deprived populations and practice workload.

He wrote: ‘A part of these changes [in 2014], the Government intends to make adjustments to the Carr-Hill formula to give greater weight to deprivation factors.

‘Previously, when our analysts explored this with the Department of Health, they encountered a paucity of relevant research and data to inform any such change.

‘The GPC believes that there are better ways to improve the health of patients in deprived areas than changing the funding formula, especially as there is little published evidence to suggest a link between population deprivation and practice workload.

‘We sincerely hope that the Government will think very carefully about what it is doing to avoid un-evidenced, unnecessary and destabilising changes to practice funding.’

Click here to read the full letter

Dr Kambiz Boomla, a GP in Tower Hamlets in east London, said practices in deprived areas should have more funding, but he criticised the way the Government was planning to implement the change.

He said: ‘The way the Government has gone about this, trying to impose it on the GPC and on doctors in next year’s contract, has made me think it is all just nonsense.

‘There is so much money being taken out of the QOF that deprived practices, as well as all GP practices, will end up with a lot less money.’

The move has been debated since 2009, when a think-tank report called for patient 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.

As part of the coalition agreement, the Government pledged to look at increasing funding for practices in the most deprived areas via a so-called ‘patient premium’.


Readers' comments (9)

  • There is no doubt deprived areas are highly likely to
    need a higher amount of attention by GPs and
    secondary care.

    It is therefore important that such areas are correctly
    identified and extra funding provided.

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  • Spencer Nicholson

    Mmmmmmmm unevidenced does anyone recall the Black report think it said something about more disease in deprived communities ergo more disease needs more money to commission the services needed to correct the health inequalities
    Smr cardiac Salford 160 smr cardiac Windsor 83 as I found out many years ago at collaborative meeting yet access rates to cardiac services was greater in Windsor than Salford

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  • Is the health economy so easily translated?

    Affluent area = longer life expectancy = more elderly with health care needs.
    Better informed = more demand = more tests/drugs prescribed by GPs.

    Yes the deprived area needs more funding overall but this doesn't translate to affluent area's GP needing less funding (which is what the government is trying to do).

    I work in mostly deprived area with small number of affluent patient from neighbouring district by the way......

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  • Bornjovial

    So those who paid little or nothing into the system will get more from it on the other hand affluent area GP`s can afford to do private practice and keep the same pay for far less work.
    Alternatively is only fair that those at risk of more illness and poorer outcomes get more funding for health.
    There is no right or wrong here.

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  • Unless expectations are changed then it is very destabilizing. I have worked in a deprived area for 13 years before the "New Contract" I earned more than in the new "affluent" area but it was easier at the beginning. I now work flat out and there is no opportunity for private practice. Thank God there's not long to go to early retirement!

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  • I thought the original Carr Hill was to fund the extra expenses of a practice/area with higher than average mortality/morbidity. It didn't really happen and then the GPCs tinkering with prevelance by squaring rooting it again had a negative effect on high prevelance areas ( generally speaking I think it fair to say high mortality/morbidity/prevelance = deprivation )
    I have no faith this new plan will deliver but I have no faith in the GPC either

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  • I think people are confusing between deprivation and health care costs. Higher mortality/prevelance does not alway equal higher cost.

    e.g. (sorry its a little blunt) 100 people happily taking tamoxifen in deprived area will cost NHS much less than 10 people who are demanding herceptin in affluent area (not just the cost of drugs but also time spent by us filling in forms and writing letters as well consulting them).

    So it's not as simple as looking as these figure.

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  • When ever there are changes there will be winners and loosers who will cry great or foul depending on which side of the line they are on. The reality is that there is a fixed amount of money to spend. The only question that matters is how is that best spent to maximise outcomes for patients as a whole nationally.

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  • I think some of us are misinterpreting what BMA?GPC is saying. The increase in funding to the GP surgeries in deprived area will not increased the provision of extra services needed for the population but it may only provide perhaps extra GP in the area. There is no evidence that Extra GPs are needed only in depreived areas as there is no correlation between the increase in GP surgery attendence and deprivation of the area. The surgeries serving the middle class and aflluent area also have similar attendence rates but onl difference is the patients may come with different problems . Therefore, increasing funding to the GP surgeries in deprived area is not the solution but it will make a good headline for the politicians.

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