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GP funding shift to deprived areas delayed until 2015

Exclusive Radical plans to alter the Carr-Hill allocation formula to reward GPs working in deprived areas have been delayed by a year, Pulse has learnt.

Pulse has learnt that a review group is currently working on changes to the Carr-Hill allocation formula that it plans to implement from 2015/16, a delay of 12 months from the date originally proposed as part of the Government’s GP contract imposition earlier in the year.

NHS England said that the formula review group included representatives from NHS Employers and the BMA and is currently drawing up options on how to alter the allocation formula for the global sum.

The GPC said that NHS England was setting an ‘arbitary’ date to complete the plans and was trying rush the ‘complex’ process of redrawing practice funding.

The global sum due to a GP practice is calculated using the Carr-Hill allocation formula, which adjusts for age and gender, patients in nursing and residential homes, healthcare needs (morbidity and mortality), list turnover and some unavoidable costs (staff market forces and rurality).

The GPC had initially agreed ‘in principle’ last year to look at formula changes as part of this year’s GP contract, but announced later that it had decided against any change at this time.

NHS England’s deputy chief executive Dame Barbara Hakin wrote to the GPC in a letter last year that the Department of Health intended to unilaterally introduce changes from April 2014 to the allocation formula to ensure it placed ‘sufficient weight’ on deprivation factors.

The change was part of a radical reform of practice funding, including the withdrawal of the MPIG and introducing ‘more equitable’ practice funding between PMS and GMS practices.

She wrote at the time: ‘Given the work needed to prepare for these changes, these changes would begin from April 2014 and would not affect the 2013/14 contract. The Department intends that these changes should include appropriate adjustments to the capitation formula to ensure that sufficient weight is given to deprivation factors.’

But a spokesperson from NHS England said that the plans to redraw the way practice funding is allocated to give greater weight to deprivation have been delayed until 2015/16.

She said: ‘The agreement to review the Carr-Hill formula in this way was made in 2011 - as alluded to in paragraph 21 of the Government response to the GP contract consultation last year. The group’s membership was agreed in 2011, in conjunction with the BMA GPC.’

‘It is co-ordinated by NHS Employers, with membership from NHS England and the British Medical Association’s Health Policy and Economic Research Unit are also on the group. The group is currently working to develop options, which will then be considered by the negotiating parties, with a view to implementation of change for 2015/16.’

The review group has no GPC negotiators as active members, instead the BMA is represented via its Policy and Economic Research Unit.

The GPC confirmed that it was aware of the existence of the formula review group but said it has not agreed any target date for implementing changes with NHS England.

GPC chair Dr Chaand Nagpaul said: ‘The Government has committed to this, and there is a formula review group, but I think it is important to not look at some arbitrary timescale for when changes should be implemented.’

‘Changing the formula is a highly complex piece of work which should never be underestimated. The past formula review group spent two years looking at revising the formula. The process needs time to be looked at properly and any proposal needs to be fully modelled, with all unintended consequences taken into account.’

‘This will take time and it should not be rushed. There will definitely be no changes for this coming year - whether it will be ready for 2015 I don’t know.’

The GPC is currently acting on the latest BMA policy on the issue, agreed at this year’s Annual Representative Meeting, to work in favour of GPs in deprived areas to be allocated a larger share of funding. But several senior members of the GPC, including Dr Nagpaul and GPC professional fees and regulation subcommittee chair Dr John Canning have opposed changes in the past.

But Dr Louise Irvine, GP in Lewisham, said: ‘As a GP working in a deprived area I want for the formula to reflect in a fair way the workload. I welcome the fact it is being revised and I hope that it leads to redressing of any imbalance that may have been there before.’