Size and market forces key to new global sum

The formula review team have identified six key elements that should be applied to a revised GMS global sum calculation and eliminated several others.

Workload
The team has developed an updated workload measure based on age-sex profile of patient list, proportion of patients registered in the last 12 months and deprivation measures linked to patients' post-code of residence.

This measure no longer includes weighting for patients in care or residential homes.

Rurality
The formula review team was unable to recommend whether this should be included.

The current formula weights for rurality because research links it with increased practice expenses per capita.

But the team said the data may be unreliable, and pointed out that the ‘unavoidable smallness' payment would also cover some rural practices.

Staff market forces factor
Global sum funding would be adjusted according to data on geographical variations in staff costs. Retained from existing global sum.

'Unavoidable' smallness
Global sums to be weighted to take account of the lost economies of scale faced by practices that are ‘unavoidably' small.

Payment would be graded according to how isolated the practice is - inner-city small practices are unlikely to benefit at all.

Consultation length and home visits
This would use consultation length and home visits data from a national research database combined with practice level age-sex profile of patients.

Cost of recruitment
This would allow for the extra cost of recruiting and retaining GPs in deprived areas.

Funding adjustments based on premiums paid to private sector staff in given geographical areas and chronic health needs associated with each practice.

End of London weighting
London practices currently receive £2.18 per unweighted patient to compensate for low global sums generated under the Carr-Hill formula.

This adjustment will now be scrapped, but the review team believes it will be balanced out by the inclusion of a deprivation measure in the workload calculation, recruitment and retention adjustments and consultation length weighting.

Weighting factors ruled out
The review team decided weighting for disease prevalence was too complicated at this stage.

Weighting for ethnicity or patients who speak a different language to their GP was ruled out because of insufficient data. Nursing home weighting was cut because data did not back it up.

A GP market forces factor was also ruled out.  

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