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GP funding shift results in 10% rise in global sum from April

The average GP practice will see a rise in global sum per patient of 10% from this April due to the planned changes to QOF, MPIG and seniority payments, NHS England has revealed.

The analysis shows that indicative global sum payments per weighted patient will rise by £6.49 – from £66.25 to £72.74 from April.

It also shows that by 2020/21, NHS England expects payment per patient to rise to £78.33 – a £12 increase compared to the current rate.

The change is based on the plans to reinvest one seventh of the value of the 2013/14 MPIG payments into global sum payments each year so that it is redistributed to all GMS practices.

The sharp rise in global sum payments this year is due to the reduced size of QOF and the abolition and reinvestment of seniority payments into the global sum.

In making the assumptions, NHS England has used ONS estimates for population growth but has not accounted for factors such as potential future changes to the funding formula, changes to the overall number of GP practices or any pay uplifts.

The figures are based on Exeter extracts as of October 2012 using data for 4,517 practices, of which 2,863 receive MPIG of some form, with monthly MPIG payment data pro-rated for the year.

In a letter to local area teams sent out at the end of last month, NHS England wrote that the majority of GP practices are expected to gain from the reforms in April, while the remainder will lose funding.

It has identified 98 practices that will be most affected and the letter also outlined a number of options for how these may be protected, including commissioning additional services; by advising them on how to work more cost-efficiently; or by agreeing new PMS contracts.

The letter said: ‘The analysis we have undertaken combines the effect of the MPIG reduction with the effect of other changes to the GMS contract that will come into force in April 2014.

‘These changes will mean reductions to QOF and seniority payments and a recycling of these funds into global sum payments… As a result, we estimate that the majority of practices will gain extra funding as a result of these changes, whilst the remainder will lose some funding.’

It added: ‘In a small number of cases where there are exceptional underlying factors (not captured by the Carr-Hill formula) that necessitate additional funding, we anticipate that area teams will need to agree different arrangements to ensure appropriate services for patients continue to be available. We have identified 98 practices nationally that will fall into this category.’

Suggested options for how area teams should handle outliers:

For practices with very small list sizes, the area team may wish to explore the following options with the practice:

  • collaborating (e.g. through federation or networking) or merging with other nearby practices to provide a more cost-efficient service;
  • identifying other ways in which the practice might potentially improve cost-efficiency, such as reviewing staffing structures; and,
  • where appropriate, reviewing other commissioning and/or contracting options

Practices providing a range of services outside their core contracts If a practice is providing a range of services outside its core contract, or
is providing services for an atypical population (e.g. a homeless
population), the area team might wish to consider:

  • whether these are services that should be funded at least on a transitional basis as enhanced services, either directly by the area team or via the local Clinical Commissioning Group; and
  • agreeing a new contract type (PMS or APMS) with the practice involved to fund some of these services through core contract, if there are special factors that warrant this approach.

Source: NHS England