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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’.