City GPs win in GMS formula review

Practices in areas of high population density, with high staff costs and rapid patient turnover would be the main winners under proposed revisions to the new contract.

A decision on whether to include weighting for rurality will affect only the degree to which these practices benefit.

Without a rurality factor, practices in the highest quartile for population density in England and Wales would receive an average 8 per cent increase in weighted list size.

Practices in the top quartile for the number of registrations in the last 12 months would receive a 7 per cent boost to their weighted list, and those in the top quartile for staff costs would receive a 6 per cent boost if the proposals are accepted.

London practices would receive an 8 per cent average increase in weighted list and practices in the DoH's 62 spearhead PCTs an average of 3 per cent.

If an additional rurality measure is included, these figures would all be roughly halved.

Practices with a high proportion of elderly patients and practices in areas of low population density appear to lose out.

Without a rurality factor, practices in the highest quartile for patients over the age of 65 would see weighted lists cut by 4 per cent. Practices in the lowest quartile for population density would see weighted lists fall by 7 per cent. Again these figures would be roughly halved if a rurality measure were included.

Medical director for specialist medical accountants PKF, Valerie Martin, said: ‘I think the proposals should be an improvement. There is a lot of research behind them and they tackle issues that were not brought into the original Carr-Hill formula, like inner-city practices that inexplicably lost out.'

GPC and formula review team member Dr Eric Rose said: ‘It is an improvement in so far as the data to back it up is much more robust and from a much larger sample of practices.'

However, he believed all practices faced certain unavoidable fixed costs and said weighting should only be applied to a proportion of pay.

Londonwide LMCs chairman Dr Stewart Drage said the removal of the current £2.18 per unweighted patient supplement to London practices' global sums was justified because practices in the city would be better off under the new deal.

However, Small Practices Association chairman Dr Michael Taylor called the revised formula ‘a slap in the face for whole-person medicine'.

The proposals would give additional support to small practices only if they are in isolated, rural areas. Changes will not be implemented until 2008 at the earliest and apply only to England and Wales initially.

  Average change in weighted patients
  Lowest quartile of practicesHighest quartile of practices
Number of GPs +3%-1%
List size
Population density
Staff (Market forces factor) -3%
New registrations -1%
Nursing and residential home patients +5%
Proportion of patients aged over 65 +8%

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