A fairer funding formula
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A fairer funding formula



Dr Kambiz Boomla ...

Dr Kambiz Boomla
Senior Lecturer and General Practitioner
Clinical Effectiveness Group
Queen Mary University of London
Chrisp Street Health Centre E14



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A fairer funding formula A fairer funding formula Presentation Transcript

  • A FAIRER FUNDING FORMULA Dr Kambiz Boomla Senior Lecturer and General Practitioner Clinical Effectiveness Group Queen Mary University of London Chrisp Street Health Centre E14 k.boomla@qmul.ac.uk
  • Minimum Practice Income Guarantee • nGMS contract came into force in April 2004 • All GMS practices have Global Sum for looking after their patients – their share of total national amount allocated for general practice • Also PMS practices and APMS practices with a more locally determined funding stream • Other funding streams going into GMS practices such as the Quality and Outcomes Framework • Global Sum Share of the national pot is determined by the Carr-Hill formula devised by Prof Carr-Hill 2
  • Carr-Hill formula • Idea is to model GP workload so practices are funded fairly for the number of consultations they are expected to need to offer • So a practice with mainly elderly patients may have a higher workload than one dealing mainly with commuters • So a practice given a Carr-Hill weighting of 1.1 will get 10% more money than a practice with the same number of patients that has the national average of 1.0 • Practices working in areas of deprivation expected to get Carr-Hill weightings of greater than 1, when they voted to accept the new contract. • But when practices got their allocation, many were very surprised that their weighting was less than the national average • So many practices found their income dropping in April 2004 that a top up was agreed, a correction factor, that guaranteed their previous level of resourcing. This was the minimum practice income guarantee – MPIG • If MPIG is withdrawn, 24 of the 100 worst affected practices are in Tower Hamlets, Hackney and Newham, demonstrating that Carr-Hill did not succeed in producing a formula that accurately dealt with the issues in many of the deprived parts of the country with greater health needs 3 View slide
  • How Carr-Hill was calculated • Factors included in the Carr-Hill formula • patient age and gender (used to reflect frequency of home and surgery visits) • additional needs: Standardised Mortality Ratio and Standardised Long- Standing Illness for patients under the age of 65 years • number of newly registered patients (generate 40% of work in 1st year) • rurality • costs of living in some area (i.e. South East - reflecting higher staff costs) • patient age/gender for nursing/residential consultations. 4 View slide
  • But are all 65 year olds the same • Age is the biggest factor affecting practice resourcing in Carr-Hill • Yet illness and need for a GP depends not on how far you are away from your birth • Rather it depends how close you are to your death • Professor Marmot illustrated this very well in his government report 5
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  • Healthy Life Expectancy Healthy life expectancy at birth by deprivation decile, England, 2009-11 Note: Decile 1 is the most deprived decile within England, Decile 10 is the least deprived. Males Females Former area Current area Area name Deprivatio n Healthy life Expectancy 95% Confidence interval Healthy life Expectancy 95% Confidence interval code code decile (years) lowe r upper (years) lower upper E92000001 England 1 52.1 51.6 52.5 52.5 52.0 53.0 E92000001 England 2 55.8 55.3 56.4 56.1 55.5 56.6 E92000001 England 3 58.4 57.9 58.9 59.7 59.1 60.2 E92000001 England 4 61.2 60.6 61.7 61.7 61.1 62.2 E92000001 England 5 63.5 63.0 64.0 64.3 63.7 64.8 E92000001 England 6 64.9 64.4 65.4 66.0 65.4 66.5 E92000001 England 7 66.8 66.3 67.3 67.7 67.2 68.2 E92000001 England 8 67.7 67.2 68.2 68.6 68.0 69.1 E92000001 England 9 68.4 67.9 68.9 69.8 69.3 70.3 E92000001 England 10 70.5 70.0 71.0 71.5 70.9 72.0 Source: ONS • 18 year gap between richest 1/10 of the population and the poorest 1/10 • 19 years for women • So very unlikely that a 60 year old from rich area will consult their GP anywhere near as often as a 60 year old from one of the poorest areas 7
  • Need for a new formula • So if MPIG is to be done away with, then a fair formula is needed • Age is still be best indicator of need for a GP • Problems with language and ethnicity – poorly recorded, could be resourced off formula • But chronological age needs to adjusted by “Healthy Life Expectancy at Birth”, so that a 52 year old living in the poorest tenth part of the country receives the same weighting as a 70 year old in the richest tenth part of the country • Multimorbidity – those with many illnesses – recent Lancet paper shows this happens 10-15 years earlier in deprived areas • Epidemiology of multimorbidity and implications for healthcare, research, and medical education: a cross-sectional study • Karen Barnett, Stewart W Mercer, Michael Norbury, Graham Watt, Sally Wyke, Bruce Guthrie • Published Online May 10, 2012 DOI:10.1016/S0140-6736(12)60240-2 • Data exists at Lower Super Output Area to allow this adjustment to be easily calculated • They both are the same number of years away from their death, and are likely to consult the same number of times • If the Department of Health modelled this variation on Carr-Hill, the need for MPIG would most likely disappear 8