Practices are meant to earn more for quality framework points in clinical areas in which they have disease prevalence above the national average.
But a flaw in the formula used to weight pay means that a single practice recording abnormally high prevalence can deny top-up payments to thousands of others, even if they record rates of disease well above the national average.
For 2006/7, a practice in County Durham that exclusively treats nursing home patients recorded 55.5 per cent of its 254-strong practice list as having dementia, 139 times the national average.
As a result, 99.7 per cent of English practices received identical disease prevalence pay weighting for dementia. Quality framework points were valued the same for practices with anything from zero prevalence to almost seven times the national average.
The practice also registered the highest rates for COPD, stroke and palliative care. Meanwhile, a London care home registered as a GP practice recorded the highest disease prevalence in England in seven of the 17 clinical domains in the quality framework.
The flaw means practices have had thousands of pounds cut from their quality framework pay. Practices of average list size could have lost up to £3,769 in potential earnings from maximum achievement in dementia, and thousands more in other domains.
Essex nurse practitioner Karla Pike estimated that half of nurses based in GP practices received bonuses based on quality framework income. She said it was unfair that bonuses were being cut by the flawed pay system. ‘Quality framework is half of our work and we are not getting fairly rewarded,’ she said.
South West London general practice nurse Lisa Eve said: ‘This is highly unfair, and it feels like we’re being kicked in the teeth for the work we do. The formula should
not allow one-off practices to affect everyone else.’
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