Editorial: Prevalence change has not been thought through

Last October, the DoH and GPC proudly announced a change to how prevalence would affect practice funding. From this year, the square root factor is to be ditched and by 2010 pay will be weighted according to true prevalence.

This plan would ensure that pay was fairly related to prevalence, both parties claimed - although, the GPC admitted, there would be winners and losers.

Practices with low prevalence could lose six-figure sums. But the GPC said that it 'hoped' LMCs would be able to negotiate extra payments from primary care organisations (PCOs) in the form of enhanced services, for example.

However, as more detail has emerged it seems that the prevalence changes could backfire in a big way.

The flaw in the plan is that there is no mechanism through which to redistribute prevalence funding nationally - the funding shifts will have to be met within PCOs, through their existing budgets.

As GP reveals this week, the change means that around half of PCOs may have to pay practices significantly more - in some cases up to £1 million more.

There is a real concern that such organisations will choose not to fund enhanced services to pay for this. Even if your practice 'wins' under prevalence it could lose out elsewhere.

Meanwhile, in those PCOs that pay out less, there is no requirement for them to spend the money they save within primary care. Again, practices may lose out.

But it is not just practice funding that is the issue. Part of the reason the DoH supports prevalence change is that it sees it as a way to address health inequalities.

But if PCOs with low prevalence will have extra money to spend, while those with high prevalence have less financial flexibility, this hardly seems like a 'fair' re-distribution of funds.

PCO funding does reflect local populations, but asking them to change the way they allocate money overnight could create more problems than it solves.

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