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Winners set for a huge income rise

Historically-underfunded GPs are set for a huge boost in funding under the proposed changes to the global sum formula.

Practices in inner-city areas and some small practices are set to benefit most, at the expense of their colleagues from small towns and shires.

The raft of changes, including use of more accurate data on practice workload and an index of multiple deprivation, comes as the culmination of an 18-month root and branch review.

A 'cost of unavoidable smallness' adjustment has been proposed to prop up the smallest and most isolated practices, along with weightings for workload, consultation length, home visits and cost of recruitment.

But the report, put out for consultation by the formula review group, made up of senior GPC and NHS Employers representatives, will be unpopular with some GPs.

It proposes scrapping the specific adjustments for factors such as the number of nursing and residential home placements and the additional needs of the population.

Most controversially of all, the report moots getting rid of adjustment for rurality on the grounds of lack of evidence – although it outlines two formulae, one with a rural adjustment and the other without.

Philip Grant, NHS Employers negotiator and chair of the review, said use of an index of multiple deprivation rather than specific markers was now possible because of innovations in data collection.

'Like any formula there is no perfect answer as it's based on assumptions and historic activity levels. But we're confident the recommendations, if adopted, would provide a more robust distribution of resources.'

The report called for London weighting to be scrapped if the proposals were adopted.

But Dr Stewart Drage, GPC negotiator and joint chief executive of the Londonwide LMCs, said: 'London practices will not lose out as the sum of the other adjustments will bring a number of improvements.'

Dr Richard Vautrey, also a GPC negotiator, conceded 'there will be winners and losers, but that's inevitable when you are changing something like this'.

How the proposed changes would work

Will adjust for:

• Workload – adjustment for age-sex bandings, newly registered and temporary patients and an index of multiple deprivation based on patients' electoral ward.

• Consultation length and home visits – developed to supplement workload adjustment, based on consultation and home visit data from the general practice research database.

• Cost of unavoidable smallness – accounts for lost economies of scale for isolated practices with 'unavoidably small list size'. If a practice is closer than 2.5km to its nearest neighbour it receives no benefit, with phased benefits between 2.5 and 4km.

• Staff market forces factor – reflecting variation in staff

costs. Under review at

present with existing methodology remaining in meantime.

• Cost of recruitment and retention – adjusts for extra costs in deprived areas.

May or may not adjust for:

• Rurality – review could not decide whether rurality adjustment should be included. Two formulae were devised, with or without adjustment.

Will not adjust for:

• London location – deemed unnecessary due to other changes.

• Patients living in nursing and residential homes – to avoid double counting.

• GP market forces factor – because private pay comparisons deemed irrelevant.

• GPs can reply to consultation at


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