Correcting the correction factor

A revised Carr-Hill formula, suitably refined and adequately funded, would measure workload reliably and remunerate practices appropriately.

Currently, 90 per cent of GMS practices are Carr-Hill losers. With a proper formula, many more practices would become Carr-Hill winners and no longer need a correction factor (CF) added to their global sum. The CF would also drop significantly in the remainder, because under a decent formula, their global sums would rise considerably.

So can the CF be phased out fairly? If increases in the global sum from practice expansion have to be subtracted from the CF, MPIG practices will need hundreds more patients before finally increasing their income. This will act as a huge disincentive to expansion.

But what if only a proportion of any increase in the global sum, say 50 per cent, were subtracted from the CF? This would certainly ease the problem, but would inevitably lead to a further anomaly: when an expanding practice eventually crossed the threshold to become a Carr-Hill winner, it would also be receiving additional money (50 per cent of its original CF) by comparison with a static practice which has always been a Carr-Hill winner. Either the system perpetuates this inequality, or the expanding practice has to suffer a sudden drop in income (50 per cent of its CF) as it crosses from MPIG to Carr-Hill remuneration.

This problem always gets in the way. Other than increasing funding for the Carr-Hill formula, I can see no way to remove the correction factor without introducing inequality or a perverse incentive.

What if we turn the whole concept on its head? Allow GPs the option of becoming salaried, with the quality framework as a performance bonus, then use the Carr-Hill formula to identify those practices with the current lowest workload. Next, let all other practices serving the same area close their books if they wish, to new patients and to allocated ones. In this way, workload would gradually even itself out in any area and no GP would lose money unfairly.

Are any of these schemes affordable by the DoH? I doubt it, so the CF will be with us for a long time. What with Carr-Hill winners, Carr-Hill losers, MPIG, the CF, PMS and the quality framework, GP remuneration remains a mess.

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