Further details of GP funding review remit revealed
Exclusive The Government has asked the National Institute for Health and Care Research (NIHR) to produce an ‘overall recommendation’ on replacing the Carr-Hill formula, which could include a departure from the existing approach.
Yesterday the primary care minister announced a six-month review of the GP funding formula starting immediately.
Now the Department of Health and Social Care has told Pulse that the research objectives (see box) of the review will be ‘scoping, developing and assessing options’ for how to allocate contractual general practice payments ‘in line with need’.
It said that the NIHR has been tasked with identifying approaches and options for a new formula that reflect patient need more accurately, including departures from the existing approach – using for example patient records and population health data.
The Carr-Hill formula currently considers six elements: rurality (measured using tax information on GP expenses); patient’s age and sex; additional patient needs (for instance, associated with morbidity and mortality); list turnover (new patients have more consultations, so more funds are needed); number of residential and nursing home patients; and staff market forces (differing staff costs depending on location).
But experts and GP leaders have argued for years that lacks a real measure of socioeconomic deprivation.
NIHR will lead the review and will engage a range of experts to inform their thinking.
The BMA said that it will be responding ‘in detail’ to the consultation, but it added that simply ‘redistributing’ funds across every practice from the same ‘obscenely small budget’ will mean as many lose out as gain and risks the destabilising of thousands of practices across the country.
First floating the new review earlier this year, health secretary Wes Streeting pledged it would result in ‘working-class areas’ receiving their ‘fair share of resources’.
The BMA has previously said that it has been told the review may need to be ‘cost neutral’, prompting warnings to avoid destabilising practices from whom funding may be removed.
The review’s key objectives
The research has five key objectives:
- Identify approaches and design options for a new allocation formula for general practice that reflects patient need more accurately. This should not be limited to the existing workload formula approach but should consider other suitable approaches including departures from the existing approach. These might include, but are not limited to
- use of patient-level needs estimates drawn from patient records-
- focus on population health data to predict need normatively,
- hybrid approaches combining utilisation-based allocation and normative allocation based on predicted need
- Provide a range of impacts of these options compared to the status quo, and the extent to which these approaches meet the government’s objectives of funding closely reflecting patient need and of reducing unmet health need.
- Assess the feasibility of implementing the identified approaches and set out barriers.
- Assess how these approaches can align with the way general practice will be delivered in the future in view of the 10 Year Plan’s ambitions on neighbourhood health and prevention.
- Make an overall recommendation on the best approach to replacing the Carr-Hill formula in order to achieve the objectives set out above.
Source: DHSC
BMA GP committee England chair Dr Katie Bramall said: ‘The BMA has long called for reform of the outdated Carr-Hill funding formula for practices and will be responding in detail to this consultation.
‘However, the real news story here is another set of what look to be broken promises from Labour. Commitments to “bring back the family doctor”; to shift NHS resource into primary care; and to negotiate a new practice contract with us in good faith are now being rapidly rowed back upon.
‘”Redistributing” funds across every practice from the same obscenely small budget will mean as many lose out as gain and risks the destabilising of thousands of practices across the country.
‘We have huge health disparities across the country, and funding to practices needs to reflect this if it is ever to be addressed.
‘But inequality is complex and general practice so fragile that it would be irresponsible to level down when patients and practices need Government to come good on its promises and level up.’
Last month, Mr Streeting told the BMA Special Representative Meeting that he will ‘work with’ GPs to avoid ‘unintended consequences’ of the formula review.
Related Articles
READERS' COMMENTS [3]
Please note, only GPs are permitted to add comments to articles
We cannot have a shifting around of a poor total funding pot as all that happens is that the inequity shifts to a different area. We need to be firm in this messaging to the DH. Provide improved funding to healthcare deprived areas with better social funding to match and don’t destabilise other areas where problems may be less evident or at least currently managed
Dreamland to think any govt will boost much needed funding for deprived areas. Either the status quo continues or redistribution arises.
I’m concerned about Rural Practices and their future. As it is much of the new funding is about centralisation / urbanisation/ Darzi approach. The biggest losers from this are Rural practices, who get a small recognition in Carr-Hill at the minute. This isn’t covering our additional costs right now, and any further cut will result in rural practices closing.
As other say -Global Sum has to rise substantially before we redistribute.