Create a prevalence formula that works

Hindsight is a wonderful thing, so it is fair of the GPC negotiators to say they could not have predicted that ‘specialist practices' with unusual patient populations could have had extreme effects on the prevalence weighting applied to the quality framework.

That said, now that it is clear that the problem — first identified by GP some months ago — is costing practices thousands of pounds, questions do need to be answered about the mechanism that many have regarded as over complicated.

The problem we have discovered is the disproportionate effect of certain ‘practices’ in reducing payments for others; for example, the inclusion in the framework of a GP service at a care home which specialises in dementia patients, and consequently a mental health prevalence of 35.4 per cent, has left practices with prevalences three times the accepted national average having their points value decreased.

Another specialised service based in a hospital has had similar effects on the stroke and CHD domains.

Any debate on changing the prevalence formula must address whether these services should be included in the calculations or indeed the quality framework at all. These are specialist services with very low numbers of patients that bear little resemblance to what we think of as ‘normal practices’.

If they are to be included, then we must address the question of rounding down practices in the top 5 per cent of the range, just as those in the lowest 5 per cent are rounded up.

Of course there is a simpler solution. Scrap what most GPs agree is an over-complicated system that does not reflect the real workload of dealing with above-average incidence of certain conditions.

In other words, apply a simple ratio of practice prevalence against national prevalence and forget rounding, adjusting and square rooting. Even the DoH could not object to a prevalence formula that ensures GPs are fairly paid for the work they do.

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