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Struggling ‘atypical’ GP practices denied £100k in promised funding



Exclusive A CCG has U-turned on a promise to provide £100,000 in extra funding for GP practices deemed ‘atypical’ under current funding calculations.

NHS England released guidance a year ago to say CCGs should identify which practices were disadvantaged by the Carr-Hill allocation formula and offer them the required support.

It said this included unavoidably small and isolated practices, university practices, and practices with a high ratio of non-English speaking patients.

Working with Walsall LMC, NHS Walsall CCG concluded two practices disadvantaged by the Carr-Hill allocation formula should share an extra £100,000.

However, the LMC told Pulse that the CCG has now withdrawn the funding offer and is suggesting it wants to discuss other means of supporting the practices.

Dr Uzma Ahmad, Walsall LMC medical secretary, said she worked with the CCG over the course of a year using ‘various tools’ to determine the gap between the practices’ GMS funding allocation and the investment needed to support their patient populations.

But according to Dr Ahmad, the CCG is now ‘not committing to [NHS England’s] guidance at all’.

She told Pulse: ‘They promised me that they would support two practices based on that, and then they found that the two practices would require £100,000 in order to fill the gap from the Carr-Hill formula. Last month, they decided not to do anything.’

Professor Simon Brake, chief officer at NHS Walsall CCG, said: ‘Support requirements for Walsall-based GP practices serving atypical populations have been raised with the CCG and, in accordance with the NHS England guidance, we are working to understand the nature of their populations and possible ways to better support these practices.’

However, Dr Ahmad said that without the additional funding it was ‘not clear’ how the practices would continue to be financially viable.

With regard to the alternative support on offer, Dr Ahmad said: ‘I’m sure it’s not going to be financial, so I really don’t know what is going to happen to these practices, with such a low resource and high demand.’

Professor Brake added that the CCG has agreed to meet the ‘atypical’ practices ‘in order to discuss how we could further support their sustainability’.

The BMA’s GP Committee, which campaigned heavily for the atypical practice funding in light of the phasing out of the minimum practice income guarantee that began in 2014/15, said the problem was a lack of money available to CCGs to follow the guidance.

GPC chair Dr Richard Vautrey said: ‘I think that this is always the challenge, that even when practices clearly have evidence that they are atypical, and that the population they serve has particular needs, it still comes back down the CCG having sufficient funding.

‘I think that is a very limiting factor in many parts of the country and is a real concern.’

NHS England declined to comment.

Funding allocations and atypical patients

The Carr-Hill funding formula, which weights practice funding based on patient population characteristics, has been subject to review for over a decade but to date no changes have been agreed or implemented.

Criticisms have included that it fails to sufficiently take into account deprivation and rurality, with the issues coming to the fore since the phasing out of the minimum practice income guarantee since 2014/15, as well as reviews to PMS funding.

To counter this, NHS England published guidance in December 2016 instructing CCGs to support ‘atypical’ practices.

This defined an atypical practice as:

  • Unavoidably small and isolated;
  • University practices;
  • Practices that have ‘a significantly high ratio of patients who do not speak English including those services designed to address the needs of migrants’.