NHS England has admitted in new guidance for commissioners published at the end of December that some practices will never be properly supported through a national funding formula.
Local commissioners have been advised to undertake reviews of practices in their areas identified as serving atypical populations.
The new guidance follows an NHS England working group on the issue convened in spring 2016 and a joint workshop with the GPC in autumn 2015.
It sets outs possible criteria for commissioners to help identify practices serving three categories of atypical populations: unavoidably small and isolated practices, university populations, and practices with significantly high ratios of patients who do not speak English.
The guidance provides commissioners with examples of schemes that could be adopted to help support atypical practices.
Bespoke enhanced services, KPIs or locally-agreed PMS contracts are suggested as options for small and isolated practices, as are contracts for practices to provide services to support secondary care, such as pre-op assessments and post-op wound checks.
University practices, which the guidance recognises may lose out on QOF funding because of low disease prevalence, while facing higher demand for mental health, substance abuse and sexual health support, could be offered local QOF or enhanced service funding for specific needs.
Practices with high non-English speaking populations could be supported with funding to recognise increased consultation times, and contractual payments or enhanced services for interpreting services.
GPC deputy chairman Dr Richard Vautrey said the guidance ‘makes clear that however much the national funding formula may be improved in the future, it won't provide sufficient funding to meet the needs of some practices that serve atypical populations’.
‘The focus is now on local commissioners to give populations in their areas confidence that their needs will be provided for through the commissioning of a sustainable general practice service,' Dr Vautrey told GPonline. 'This will require bespoke funding solutions which may vary from practice to practice, but as the guidance makes clear, it would be helpful to share these examples so that the national guidance can be developed further.’
Parallel work by NHS England, the BMA, the DH and academics to review and improve the GMS Carr-Hill funding formula is not expected to be implemented before the 2018/19 contract.
Photo: JH Lancy