Bid to fix flawed prevalence formula

BMA plans to improve the prevalence formula depend on the DoH's overall settlement.

Laurence Buckman
Laurence Buckman

A flaw in the quality framework's prevalence formula, which has seen practices with twice the average prevalence of some conditions paid the same as those with none, could still be fixed by April, the BMA has claimed.

'The current position won't stay, that's certain,' said Jon Ford, the head of the BMA's health policy unit. 'NHS Employers and us are of one mind.'

But any solution is likely to depend on the scale of the increase in the overall budget for GPs.

Practice income will not increase if GPs reject the 1.5 per cent increase offered by the DoH.

Dr Laurence Buckman, chairman of the GPC, said that a change to the prevalence formula was 'actively being negotiated', but that the BMA was wary of unintended consequences.

'Whatever happens, this has to be sorted out. There is an inherent and unwitting unfairness in the way the formula has worked,' he said. 'The problem is making sure that the people the formula was designed to protect aren't damaged by any change.'

Mr Ford said that the BMA was keen to find a new formula that did not see any practice lose income. This should not be a problem 'as long as there's sufficient leeway in the uplift', he said.

The prevalence element of quality framework pay has been widely criticised by clinicians. Practices in the bottom 5 per cent of the range reported nationally are rounded up to the 5 per cent mark to top up their pay.

But this means that practices with unusually high prevalence, such as those in care homes, distort national averages, pushing a disproportionate number of practices into the lowest bracket.

Mr Ford said that three options were under consideration: changing the 5 per cent cut off point, changing the square rooting used to reduce the range of prevalence data, or taking out all adjustments and using raw prevalence data.

An NHS Employers spokeswoman confirmed that discussions were under way to deal with the anomaly but was unable to comment on their contents.

The GPC plans to poll GPs on the DoH's proposals for the GMS contract in mid-February. If the offer is rejected, the DoH may impose a settlement.

Prevalence review

Three options under consideration:

  • Changing the 5 per cent cut-off point.
  • Changing the square rooting used to reduce the range of prevalence data.
  • Taking out all adjustments and using raw prevalence data.

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