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The 'funding uplift' is another nail in the coffin for my practice

From Dr Sanjeev Juneja, Rochester

I wonder what the Government meant when they said the uplift will compensate for increase in CQC fees. Although the GPC hailed it as a real uplift at last, at my practice, it doesn’t cover any increase in costs. The deficit has only deepened.

My practice, Marlowe Park Medical Centre in Rochester, has this year faced an increase in CQC fees of £1,600 and indemnity payments have increased £8,600 per year over the last two years. This means that despite the 2016/17 contract’s ‘funding uplift’ increasing payments to £80.5 per patient, we ended up with a monthly increase in global sum of only £114.51 from 1 April 2016 for a list size of 3,992 - a paltry 0.05% increase.

Marlowe Park has an overall good CQC rating but has had the lowest payments per patient in the Rochester and Strood locality for the last two years running at £91 and £96.12 per patient. It caters to the highest percentage of patients with learning disabilities in Medway, and more than 10% of our patients are on the depression register, mostly young people. The practice is in a deprived area and has a deprived population but statistically it is not a deprived area for payment purposes. Attempts to get a partner have failed as the last candidate vanished without a word when given a copy of the latest practice’s tax return.

The Government’s reluctance to do away with the Carr-Hill formula is astonishing. The disastrous effect of this lies starkly exposed as a reduction in patient list size by 117 resulted in a drop in weighted list for payment purposes by 207 patients. This defies all logic as the number of patients above 75 fell only by four.

Our average GP earnings are £32k and this after me working almost seven days a week with no vacations for two years.

The lack of a ‘funding uplift’ is the final nail in the coffin and we have now escalated the matter through NHSE to HSCIC and hope a solution will give us a reason and support to avoid having to sell the premises and terminate the contract.

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Readers' comments (23)

  • I thought you were retiring/leaving in September?

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  • under 4500 patients it won't even go to procurement if you hand it in either - so you're stuck with a loss.

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  • You have not included your extra NI announced in the budget and staff pay rise you can add another £10k to your losses

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  • @Zishan: As you can see- leaving or retiring is possible only if I can ensure continuity and have a clear conscience and an intact pocket considering the great patients I have and the mortgage dangling above. Hope that makes sense.

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  • How many nails in the coffin are you waiting for? Ditch the contract!

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  • The magic of Carr Hill works like this. I'll illustrate with an example-
    In 2015-16
    1st Quarter - Drop in list size by 16 patients resulted in reduction in weighted list size by 35 patients

    2nd Quarter- Drop in list size by 8 patients resulted in reduction in weighted list size by 58 patients

    3rd Quarter- Drop in list size by 15 patients resulted in reduction in weighted list size by 71 patients.
    In this quarter it appears for every patient leaving the Practice the payment is reduced for almost 5 patients !!!

    On the other hand, when the list was growing in 2014:

    1st qtr: Increase in list size by 77 patients resulted in weighted list increase only by 47 weighted patients
    2nd qtr: Increase by 103 patients increased weighted list by 97 patients
    3rd quarter: Increase by 26 patients resulted in only 13 patient increase in weighted list of 13.
    Conclusion: Carr Hill is a key to a centrally controlled corrupt mechanism which will always go against GP.
    Last year the Exeter person advised that my data was being manipulated at the local level but he wouldn't agree to give it in writing as 'My boss, won't be happy'.
    Who's the boss? I would very much like to know.
    This Year Marlowe Park got an uplift of 2 (TWO)pence per registered patient per month.
    How many other Practices are in the same situation? Please share.

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  • My goodness, what a dire situation. You have to look after yourself now and do what ever you have to do.

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  • Surely not being paid for the number of patients you are looking after is fraud?
    The government is defrauding you with respect to this. You should work out how much they owe you in back payment and charge them. Or start a campaign to highlight this important point and get others to give their figures too. Otherwise there is no way forwards.
    Attack is the best form of defence and if they have been withholding payments to your practice for years, they should pay for it.
    I know the BMA are usless but with such a low income, would you qualify for free legal support?

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  • @Other healthcare provider:
    For two years I have highlighted his 'discrepancy' but have been repeatedly told by LMC and NHSE this is correct. However, this year I threatened to take legal action for a different reason.
    We realized that if patients are living beyond 3 miles you may be eligible for 'rurality' payments. However, on Exeter statements there was no mileage for our patients so we put mileage manually for every patient.
    It turned out we had more than 900 patients living beyond three miles and then suddenly on Exeter statements we had Additional/Fringe data appear which read-
    Total payment units (deprivation/rurality)= 4900
    However, payments were coming for only 3500 approx.

    Interesting fact is that when we started putting in mileage manually, within hours we had a phone call and emails from PCA to stop doing it as it is picked up automatically by Exeter. We refused to stop inputting explaining that Exeter was not picking it up for the last few years. We would input mileage for 80 patients, in the evening PCA would remove it. This carried on for a while and we reported to LMC, then they stopped removing mileage.
    Incidentally, payments were never made.

    BTW, the mileage data on the online registration form is in section to be filled by PCA.

    Now, finally, PCA has agreed to log a call to HSCIC to look into the matter.
    The problem is that we are only one small Practice.

    What is the scale of this error/manipulation, we don't know. Is it an error in the Exeter systems, is it laziness on the part of PCA officials or is it a deliberate mechanism to fleece Practices.
    That is the question that needs answering.

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  • The thing is we don't have any details of how exactly it is worked out, so how can you tell whether the details are correct or not.

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