The Association of Independent Specialist Medical Accountants, which represents over 3,600 NHS GP practices, has set out the criteria it believes will lead to a successful outcome of the Carr-Hill funding formula review for GP practices.
AISMA leaders say that to be judged a success for general practice, the funding review should result in additional investment in the global sum; have the backing of a data-led analysis of the problems deprivation causes in primary care; and recognise that a separate funding mechanism is needed for rural and atypical practices.
They also call for any new formula to be tested rigorously to ensure it does not recreate unintended financial consequences for practices that could lead to GP partners leaving the profession. Any new formula should be introduced on a planned, phased basis they say.
First and foremost AISMA leaders say the overhauled funding formula must give practices certainty that their core funding will provide the financial baseline they need to operate.
Lizzy Lloyd, AISMA Chair and partner at east of England accountancy firm Larking Gowen, says: ‘It’s essential the new formula for the global sum delivers enough money for all practices. If the output of the review is to simply redistribute existing money this won’t work.’
AISMA Board member Sue Beaton, a director at Coveney Nicholls in Surrey, says: ‘Many practices are struggling, but some are struggling more than others. Increased global funding will be needed if the government’s goal of moving work from secondary to primary care is to be realised without taking funds away from existing practices.’ She adds: ‘Simply taking away money from the ‘affluent’ areas and giving it to the deprived areas will not be sufficient or even fair.’
According to AISMA, the review should also be backed by a robust analysis on the causes of deprivation. Board member Pete Farrier, director of Hampshire firm Morris Crocker Chartered Accountants, says: ‘A data-led model is needed to analyse the problems deprivation is causing in primary care, rather than just say deprived areas suffer more. What are the root causes? Which primary healthcare services can help solve these issues? The NHS should not be expected to sort out problems caused by poor housing and the lack of social care for elderly and disabled people.’
Turning to the outdated age and sex weightings in the Carr-Hill formula, Mr Farrier says: ‘The new formula must dispel the myth that GP practices with younger populations carry out less work and therefore require less funding. Likewise having an older list size does not necessarily equate to higher demand.’
Ms Lloyd adds: ‘Each population group has changed so much since the introduction of the Carr-Hill formula. Practice funding must reflect more accurately the support needed for children’s mental health and mental health services more generally and other areas such as menopause.’
The accountants also say a separate funding mechanism is needed for atypical practices, including rural practices with patient populations spread across large geographical areas. ‘These practices have higher operational costs, for example by needing to operate branch surgeries in rural areas,’ says AISMA adviser Andy Pow who is based in Cumbria. ‘A universal funding formula will never work for practices that fall outside the norm, including many rural practices, those with a high percentage of patients who do not speak English as a first language, and practices with big student populations.’
Other considerations for those carrying out the Carr-Hill review suggested by AISMA accountants include implementing a more frequent review cycle to account for evolving health challenges. They also say there should be a focus on the income practices receive for temporary residents which is based on historical data prior to 2004 and may not reflect today’s demand. Of particular concern to Ms Lloyd is practices who have reverted from a PMS contract to GMS, merged practices or practices who have taken on new GMS-based contracts. ‘These practices receive no payments for temporary residents which simply isn’t fair,’ she says.
AISMA also suggests the review presents the opportunity to move away from a mainly capitation-based payment approach. AISMA Board member Kieran Hancock, a healthcare director at Forvis Mazars in Manchester, says: ‘If the government wants a GP workforce who can deliver appointments and keep patients out of hospital, perhaps now is the time to start paying practices for what they do, rather than by the number of patients on their list. This could mean practices being reimbursed for the number of appointments they deliver, the mix of staff used to deliver the appointments and the complexity of each case.’