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GPC discussing separate contracts for rural and atypical practices



Exclusive Practices with ’atypical’ populations – such as rural practices and those treating high numbers of homeless people – could be given their own contracts under plans being discussed by GPC and NHS England, Pulse has learnt. 

The chair of the GPC, Dr Chaand Nagpaul, told Pulse that the contracts under discussion – which could be national or local – is one option to solve problems exposed by the withdrawal of the minimum practice income guarantee and PMS premiums.

The GPC, NHS England and LMCs agreed last month that the ongoing review of the Carr-Hill Formula – which determines the basic global sum received by practices based on the demographics of their patients – will be unable to devise a formula that is fair for all practices. 

Changes to the formula have been under consideration since 2007, partly because of concerns that practices with atypical populations, or those in deprived areas, do not receive sufficient funding to support them to treat their patient demographics.

Dr Nagpaul told Pulse that these problems have been ‘masked’ by the MPIG and PMS premiums, which the Government is now withdrawing.

He added it is ’simply not possible to have a single national contract that can do justice to the specific needs of practices that have certain atypical populations’.

Dr Nagpaul said: ’So in some cases it may be possible to look at a contract designed for the needs of certain categories of practices. In other cases the atypical nature may be very specific to the practice, which would need a very particular arrangement.’

According to the GPC’s newsletter, the ’atypical’ populations under discussion at the meeting included: rural and isolated practices; practices with young populations; practices caring for homeless, drug users and nursing home patients; university practices; practices with large numbers of temporary residents; and practices with a high proportion of non-English speakers. 

However, the newsletter also made clear that the new contracts will not apply to all these groups, and NHS England will report to the Carr-Hill Formula review steering group regarding which populations could be included in that review, and which would require an alternative solution.

An NHS England spokesperson said: ’We have previously committed to reviewing the GP funding (Carr-Hill) formula and we restated this as part of the wider New Deal for general practice.

’We continue to work with the GPC on the review with the aim of adapting the formula to better reflect workload and deprivation. This work continues and we will communicate further in due course.’

Pulse has already revealed that changes to the Carr-Hill formula will not be made for the 2016/17 contract, despite previous suggestions they will be introduced next year.