NHS England has asked regional teams and CCGs to identify ‘atypical’ practices that are ‘unavoidably small and isolated’ or have high numbers of patients who do not speak English, to receive additional funding above and beyond their GMS contract allocation.
It has published guidance for commissioners outlining which practices may require the additional funding – which was announced by NHS England last year after Pulse revealed it was under discussion in 2015 – as well as ways to allocate this.
NHS England says that ‘there are some practice populations that are so significantly atypical that using the GMS funding formula would not ensure the delivery of an adequate general practice service’, including ‘unavoidably small and isolated’ practices, university practices, and practices with ‘a high ratio of patients who do not speak English’.
It suggests that such practices could potentially be supported be via ‘a bespoke enhanced service’, or ‘added formally into a PMS agreement’.
The guidance says that, when deciding if extra funding is required for small and isolated practices, local commissioners should look at factors such as:
- Average population density and average distance from patient residences;
- Ambulance response times;
- Whether the practice provides additional or extra services that are not additionally funded; and
- Whether the practice income adequately covers the cost of providing services when comparing practice data
For university practices, commissioners should look at factors such as comparative consultation rates, prevalence of disease not covered by QOF and registration data in September-October to identify student registrations and de-registrations over the summer, it adds.
While, for practices with a high number of non-English speakers, commissioners should look at the percentage of patients requiring an interpreter, consultation rates compared with the average; and average length of consultation.
The guidance also sets out non-financial means of support for atypical practices, including promoting online support tools to patients, increased use of text messaging and online administration and a local QOF or enhanced services for the population’s specific needs.
The guidance document says: ‘Support for practices should directly impact on patient care as well as the long-term viability of practices, and therefore commissioners are encouraged to undertake a review of identified practices in their area.
‘By reviewing the practices in your area, commissioners and providers can identify practices that require such support. Without this support many practices will be unable to maintain the service and as a result health outcomes may suffer.’
NHS England has run a working group looking at atypical practices alongside its review into updating the Carr-Hill funding allocation, after agreeing with the GPC that some practices’ situation was not adequately captured by the formula.
NHS England, which has previously said this was in response to the BMA’s Urgent Prescription for General Practice, recently said the updates to Carr-Hill will not come in until April 2018.