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GP practices with ‘atypical’ population set to receive extra funding

GP practices with ‘atypical’ circumstances should be funded through ‘bespoke’ arrangements made by CCGs, NHS England has said. 

Under the new plans, university practices, ‘unavoidably’ small and isolated practices and those with a significant percentage of patients who cannot speak English will have separate local arrangements for core funding.

NHS England said that the move – first revealed by Pulse last year – comes in response to demands from the GPC’s Urgent Prescription for General Practice.

It comes in the same week that the GPC is announcing whether it will ballot GPs on potential industrial action, which it said it would do unless the proposals from the Urgent Prescription for General Practice were put in place before the end of August.

NHS England has also announced that the Carr-Hill formula changes will be delayed yet another year, to April 2018.

In an announcement today, NHS England acknowledged that certain practices required a separate funding formula, as many of their characteristics cannot be captured by a generic formula.

Practices with atypical populations have been particularly badly hit by changes to PMS and MPIG funding, with many having to close as a result of losing essential funding.

A spokesperson for NHS England said: ‘It is recognised that, due to the wide diversity of populations served by GP practices, a national formula will never be able to accommodate the workload needs of all practices. We know that a number of practices provide services to patient populations that have characteristics that affect the practice’s costs or workload in a way that cannot be captured through a formula.

‘Therefore, in parallel to the development of the new national funding formula, we are in the process of developing national guidance for commissioners which will focus on three such population types.’

GPC deputy chair Dr Richard Vautrey said ‘there was a need to identify additional support for practices that a national formula would never be able to provide proper levels of funding for’. 

He added: ‘I think all parties recognised that there was a need to focus on these specialised practices. So we have been working on guidance with NHS England which I think is getting to the point now where it could soon be ready for publication.’

According to Dr Vautrey, these special funding arrangements should come into force well before the Carr-Hill formula review is concluded.

He said: ‘Absolutely. There is no reason why a CCG or local regional NHS England area could not look at providing more support to these particular groups of practices. The numbers of practices are very small, but it has a massive impact for the individual practices.’

Meanwhile, the news of yet another delay to the implementation of Carr-Hill formula review changes appeared to mark the first missed target in the General Practice Forward View – which had pledged that negotiations on these changes would conclude this summer.

But NHS England’s spokesperson said: ‘NHS England and the BMA want to ensure that we deliver on the commitments made in the General Practice Forward View – to deliver fairer distribution of funding. We want to achieve this in a way that does not threaten stability and in a way that does not cause financial uncertainty for practices.’

They said that ‘although NHS England and the BMA will now start the detailed negotiations on the new funding formula, we can confirm that we will not seek to implement any changes to the funding formula before 1 April 2018’.

NHS England said that it believes ‘that this timescale will allow time for better forward planning by practices, better engagement with the profession and patient involvement, if this is required’.

Dr Vautrey said that the decision to delay these changes were ‘sensible’.

He said: ‘We have repeatedly said that the review process is complex, we need to get it right and we can’t rush a formula process that inevitably would lead to winners and losers if you work within the existing financial envelope.

GP practices in deprived areas have argued that the allocations formula, which weights practice income based in age as well as deprivation factors, was not in their favour since this was rolled out in 2004.

But the GPC has warned against making sweeping changes to the formula that could destabilise other practices.

Please note: this was changed at 11:55 on 17 August 2016 to reflect that NHS England has not proposed a new funding formula, but instructed CCGs to top up funding for atypical practices

Funding allocations and atypical patients

The Carr-Hill formula, first adopted in 2004, weights GP practice funding based on patient population characteristics such as age and deprivation. It has been under review since 2007, and the 2010 Coalition agreement pledged to look at fairer distribution of funds to practices in deprived areas.

The findings of the Carr-Hill review launched in 2007 were never implemented, but another technical group was formed in March 2012 to implement the then-Coalition Government’s pledge for a ‘patient premium’ for practices with the most deprived populations to further alleviate health inequalities.

Changes were initially agreed in principle for 2013/14, then postponed to 2014/15, and then to 2015/16 but have, as yet, never been implemented.