GPs in Leicestershire have criticised a local primary care funding model in their area, which was lauded in a major NHS England-commissioned review.
In May last year, Dr Claire Fuller, the chief executive of an Integrated Care System (ICS) in Surrey and a GP herself, published her report on integrating primary care with other NHS services.
This highlighted a local pilot whereby the cost-of-staff element in the Carr-Hill formula calculation has been replaced with a needs-and-deprivation element.
The stocktake said that in Leicester, Leicestershire and Rutland action was taken to address inequalities in the existing primary care funding model, ‘which is primarily driven by age and gender and not reflective of actual patient need at practice level.’
It said that ‘underfunded areas were the most deprived’, adding that the Leicestershire model aims to tackle this by calculating practice payments through ‘setting aside the core staff components based on the current practice core contract income’, as calculated in the Carr-Hill formula.
‘The remainder of core contract funding and other funding in the model is distributed to practices based on needs and deprivation.’
It added that ‘approximately £3m’ was identified to rebalance funding based on ‘need and demographics’.
But Dr Grant Ingrams, executive chair of Leicester, Leicestershire and Rutland LMCs, told Pulse that a survey run by the committee found opposition to the model.
The LMC conducted the survey as they said there were being contacted by many practices who ‘did not understand or agree to the model’ and received 109 replies.
Some of the survey responders said that the system was ‘very unclear’, ‘poorly handled’, ‘chaotic’ and ‘inadequate.’
One of the responders said the primary care funding model (PCFM) had ‘been changed so many times I couldn’t tell you what is expected from practices’.
‘What’s included and not has become so diluted with and poorly handled, they need to release a final (and make it final) explanation with the specs attached.’
Another said: ‘It’s very unclear, it would be nice to have a step-by-step guide of what is included in the PCFM, basket of services and global sum. If it could be broken down to what we had last year and where that income is now sitting.’
Another responder said that the funding ‘quite simply isn’t adequate to deliver what is being asked, especially in terms of wound care.’
Dr Ingrams told Pulse that particularly at the beginning communication was ‘poor,’ and that even recently ‘changes have been made without agreement with the LMC.’
He said: ‘With regard to the levelling up component the pro is that practice funding is made more appropriate for the demography, and rectifies the known faults with the Carr-Hill formula which has not been sorted nationally.
‘The cons is that if a practice accepts this funding they are required to provide the list of other services which has been constantly added to by the ICB.
‘The process was in place for practices in Leicester city for many years, but the model now expands it across the whole of the Leicestershire, Leicester and Rutland area.’
He went on to explain that: ‘The main problem is that the “levelling up” part is no longer “no strings.” The underlying purpose was to provide more appropriate funding for core services, but it actually includes requirement for practices to provide “non-core” services, secondary care initiated phlebotomy, primary and secondary care phlebotomy, complex care, and medicines optimisation framework.
‘The LMC’s view is that “levelling up” should only be the fair share distribution of funding to provide “core services” only.
‘In effect the current agreement makes this list of additional services “mandatory” if practices want to access the fair share funding, which are practices providing services to deprived populations, with the additional challenges that this brings.’
A spokesperson for the Leicester, Leicestershire and Rutland ICB said: ‘We have been working closely with the LMC for some time regarding the funding model and we appreciate their engagement with us and the feedback they have provided from practices.
‘We have introduced ongoing initiatives to support practices and ensure that the process is clear. We are also pleased to confirm that we have secured additional funding for primary care, in order to support work to address health inequalities.’
The Fuller stocktake’s main recommendations were around ‘enabl[ing] primary care in every neighbourhood to create single urgent care teams and to offer their patients the care appropriate to them when they pop into their practice, contact the team or book an online appointment’.
Dr Fuller also said that NHS England should consider ‘combining and simplifying central programme and transformation budgets for primary care.’
The Government, upon unveiling its urgent care plan last week, said this will be ‘aligned with priorities for primary care,’ including the forthcoming GP access recovery plan and the implementation of the Fuller stocktake report.
What did the Fuller Stocktake report say?
In Leicester, Leicestershire and Rutland action has been taken to address inequalities in the existing primary care funding model, which is primarily driven by age and gender and not reflective of actual patient need at practice level.
They are also tackling disparities in service provision; a population health-based model found that underfunded areas were the most deprived.
The new model calculates practice payments by setting aside the core staff components, based on the current practice core contract income.
The remainder of core contract funding and other funding in the model is distributed to practices based on needs and deprivation. As a result, approximately £3 million was identified to rebalance a fairer level of baseline funding across all practices, based on need and demographics, and the model enables future investments in primary care to be transparently distributed at practice and place, based on population health need.
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