Exclusive: GP quality pay cut by £7,000

Thousands of practices in England have had up to £7,000 each cut from their quality pay because care homes were included in the quality framework, a GP investigation can reveal.

These losses apply to the mental health domain alone and further losses of up to £1,000 may apply to other domains.  

In total, GPs in England with high numbers of chronically ill patients have lost hundreds of thousands of pounds in 2005/6.  

This is because of a flaw in the way prevalence is calculated.  

A care home and a PMS practice for nursing home residents reported England’s highest prevalence in half of the quality framework’s 10 domains. The rates of disease reported were up to 60 times the national averages.  

The 250-patient Nightingale care home in Wandsworth, south London, which contains a dementia unit, reported mental health prevalence of 35.4 per cent, compared to the national average of 0.6 per cent.  

The PMS Galvani Practice in Middlesbrough cares for just 63 nursing home patients, and reported stroke and COPD prevalence 15 times and 13 times the national average respectively.  

The inclusion of these data almost completely wiped out practices’ positive disease prevalence pay weighting for mental health in 2005/6 and significantly cut pay in other domains.  

Some practices would have earned up to £7,000 more in the mental health domain alone if care homes had been excluded, while losses to practices with average list size were up to £2,500.  

As a result, 97 per cent of practices, with prevalence ranging from 0 per cent to almost 1.8 per cent for mental health — three times the national average — earned the same per point in this domain. They all received a mental health prevalence factor of 0.99, cutting the basic value of a quality point from £124 to £122.76.  

This inflated the value of points in the domain for practices with low prevalence, but left more than 3,000 practices with above-average mental health prevalence facing a pay cut.  

GP leaders admitted they did not anticipate the problem. They promised to investigate and will consider possible changes to how quality pay is weighted on the basis of disease prevalence. They will also consider moving points between disease domains to compensate for poor pay distribution.  

GPC deputy chairman Dr Laurence Buckman said: ‘If the effect is as large as you describe we will have to do something.  

‘We adjusted points last year to take account of skews. If we find it is not just point awarding but the prevalence calculation that generates a problem, we will look at that too.’  

He said any change to the formula would probably apply to all clinical domains of the quality framework. He warned it would be vital to ensure changes did not cause further imbalances. 

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