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GP practices with 'atypical' population set to receive extra funding

GP practices with 'atypical' circumstances should be funded through 'bespoke' arrangements made by CCGs, NHS England has said. 

Under the new plans, university practices, 'unavoidably' small and isolated practices and those with a significant percentage of patients who cannot speak English will have separate local arrangements for core funding.

NHS England said that the move - first revealed by Pulse last year - comes in response to demands from the GPC's Urgent Prescription for General Practice.

It comes in the same week that the GPC is announcing whether it will ballot GPs on potential industrial action, which it said it would do unless the proposals from the Urgent Prescription for General Practice were put in place before the end of August.

NHS England has also announced that the Carr-Hill formula changes will be delayed yet another year, to April 2018.

In an announcement today, NHS England acknowledged that certain practices required a separate funding formula, as many of their characteristics cannot be captured by a generic formula.

Practices with atypical populations have been particularly badly hit by changes to PMS and MPIG funding, with many having to close as a result of losing essential funding.

A spokesperson for NHS England said: 'It is recognised that, due to the wide diversity of populations served by GP practices, a national formula will never be able to accommodate the workload needs of all practices. We know that a number of practices provide services to patient populations that have characteristics that affect the practice’s costs or workload in a way that cannot be captured through a formula.

'Therefore, in parallel to the development of the new national funding formula, we are in the process of developing national guidance for commissioners which will focus on three such population types.'

GPC deputy chair Dr Richard Vautrey said 'there was a need to identify additional support for practices that a national formula would never be able to provide proper levels of funding for'. 

He added: 'I think all parties recognised that there was a need to focus on these specialised practices. So we have been working on guidance with NHS England which I think is getting to the point now where it could soon be ready for publication.'

According to Dr Vautrey, these special funding arrangements should come into force well before the Carr-Hill formula review is concluded.

He said: 'Absolutely. There is no reason why a CCG or local regional NHS England area could not look at providing more support to these particular groups of practices. The numbers of practices are very small, but it has a massive impact for the individual practices.'

Meanwhile, the news of yet another delay to the implementation of Carr-Hill formula review changes appeared to mark the first missed target in the General Practice Forward View which had pledged that negotiations on these changes would conclude this summer.

But NHS England's spokesperson said: 'NHS England and the BMA want to ensure that we deliver on the commitments made in the General Practice Forward View – to deliver fairer distribution of funding. We want to achieve this in a way that does not threaten stability and in a way that does not cause financial uncertainty for practices.'

They said that 'although NHS England and the BMA will now start the detailed negotiations on the new funding formula, we can confirm that we will not seek to implement any changes to the funding formula before 1 April 2018'.

NHS England said that it believes 'that this timescale will allow time for better forward planning by practices, better engagement with the profession and patient involvement, if this is required'.

Dr Vautrey said that the decision to delay these changes were 'sensible'.

He said: 'We have repeatedly said that the review process is complex, we need to get it right and we can't rush a formula process that inevitably would lead to winners and losers if you work within the existing financial envelope.

GP practices in deprived areas have argued that the allocations formula, which weights practice income based in age as well as deprivation factors, was not in their favour since this was rolled out in 2004.

But the GPC has warned against making sweeping changes to the formula that could destabilise other practices.

Please note: this was changed at 11:55 on 17 August 2016 to reflect that NHS England has not proposed a new funding formula, but instructed CCGs to top up funding for atypical practices

Funding allocations and atypical patients

The Carr-Hill formula, first adopted in 2004, weights GP practice funding based on patient population characteristics such as age and deprivation. It has been under review since 2007, and the 2010 Coalition agreement pledged to look at fairer distribution of funds to practices in deprived areas.

The findings of the Carr-Hill review launched in 2007 were never implemented, but another technical group was formed in March 2012 to implement the then-Coalition Government's pledge for a 'patient premium' for practices with the most deprived populations to further alleviate health inequalities.

Changes were initially agreed in principle for 2013/14, then postponed to 2014/15, and then to 2015/16 but have, as yet, never been implemented.

Readers' comments (13)

  • GPC has it's worries but it is time that having 25-30% of your list with people with language problems is recognized for funding streams. Young populations with extra needs due to depression/drugs and other MH social issues also need to be taken out. As for populations with students, no Practice is viable around the campus if the Carr-Hill formula is applied. Finally a step in the right direction unless again favouritism and corruption undoes it all.

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  • Let me see if I understand this correctly....

    Practices who have atypical populations are going to get a correction factor to account for some of the differences they have from standard populations.

    All this immediately on the aftermath of removing MPIG and PMS contracts.

    What is the point?
    Are they just moving things back and forward to keep a few managers in work?

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  • ^^^^^wot s/he said

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  • What about high elderly practices? I know of one 40% over 65 - surely that gets shafted by Carr-hill?

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  • This will get shunted again next year as all focus is on MCP's.

    Carr-Hill is an absolute joke.

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  • We need to move away from the current capitated model to a Fee for service model where the more pts you see or deal with (for whatever it pt demand, secondary care dumping or deprivation) is rewarded. In such a system there is no need for any funding 'formula'...the busier you are the more money you earn...simple really....just need to get rid of the outdated and underfunded GMS contract.

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  • Jersey and Guernsey
    Fee for service
    Worth a look
    Form your own opinions

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  • Peter Swinyard

    The sentiment about fee for service is good - but can you imagine the Daily Wail accusations of gaming? "Just come back next week, Mrs Bloggs so that I can check to see if your throat is any better" and if that is banned - how about the management style of inviting severely depressed patients back weekly? I find that a dose of the Drug Doctor in the early stages is effective. "OK partners, we're having a slow week and a tax bill's on the way - so let's increase our recall rate for the next month shall we?"

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  • 8:28: Indeed, practices with patients above 65s also need to be taken into consideration
    @Nishan: True, this model is outdated though pressures have to be recognized on populations.
    GP Registrar: Carr-Hill is a big joke but not funny anymore to most Practices and the matter will get shunted further as is every year. Did we not hear of it's liquidation a few years ago?
    @Peter: On the mark with that fee for service and I've seen how it works in Australia with GPs coming in at night to do scripts for patients and charging for night visits on a sliding scale from AUD 128 per patient.

    Finally, Anonymous:11:18 -
    Jersey and Guernsey are the best examples but is that really possible. That could be one good solution for most of the woes of GP land. They do operate in a different financial system being a tax haven and how much of their health system can be assimilated in England is debatable.
    The problem remains that this government has a different agenda with no inclination to make things improve and that is where the buck stops.

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  • The problem with the formula approach to allocating money from an inadequate fixed price cake (apart from the fact that the total cake is inadequately funded obv) is that however you cut the cake it will remain inadequate. In particular it is inadequate in that it doesn't take into account the sums needed to meet the fixed costs of safely delivering our core contractual demand we daily face. Switching to an item-based contract alone won't solve that. There has to be an elements to cover fixed core practice costs, an element to cover the number of patients either as capitated or as payments for specific services, or a combo of both.

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