In a joint statement, the national commissioning body and the doctors’ union confirmed they were beginning detailed negotiations on a new funding formula, but would not seek to implement any changes before April 1 2018 in order to protect practices from financial instability.
New guidance is also set to be issued to commissioners on 'bespoke' support for practices with atypical populations not properly funded through the national formula. NHS England said that support would be in the form of supplementary payments for practices on top of existing funding.
GPonline understands that the Carr Hill technical review group has yet to complete its work, which was due to conclude this summer, looking at how practices with populations underfunded by the formula are affected by possible changes.
The technical group, which was established by negotiations for the 2015/16 contract to review the Carr Hill funding formula and is made up of GP representatives, NHS officials, academics and funding experts, was due to report in time to inform negotiations for the 2017/18 contract.
The group is now modelling the effects of possible formula changes on practices affected by ongoing funding changes, such as the MPIG phase-out and seniority recycling and PMS reviews.
Fairer funding distribution
NHS England and the BMA said that while they wanted to deliver fairer funding distribution ‘we want to achieve this in a way that does not threaten stability and in a way that does not cause financial uncertainty for practices’.
Some GPs have argued that the formula fails to properly fund the additional workload associated with deprivation and other atypical practices, and that it creates too much funding variation.
The statement confirmed, as reported by GPonline in February, that new guidance for commissioners is being developed for 'bespoke' support for atypical practices.
Focused on university practices, unavoidably small or isolated practices, and those with large numbers of non-English speaking patients the new guidance will ‘illustrate for commissioners the workload challenges that practices face and guide commissioners to relevant data sources or intelligence to assist them in making decisions regarding sustainable support’.
Commissioners are expected to be asked to consider supplementary payments to fund aspects of their patient list not recognised through the national formula.
GPC deputy chairman Dr Richard Vautrey said: 'We've agreed with NHS England that there should be a delay in this process as the work is still on going, reflecting the complexity of the project. At a time when practices are already under huge strain we need to be sure that any new formula is as good as it could possibly be before considering it's implementation.
'The work on atypical practices stems from pressure from GPC and a workshop we organised last year as it was recognised that no national formula, no matter how good, could provide the right levels of funding to ensure stability for these practices and local solutions would be needed. We've involved LMC representatives who have direct experience of practices serving atypical populations, particularly those in remote rural areas, those servicing predominately students and those where consultations regularly take place with the need for translation services. Guidance is being produced on how CCGs and NHS regional teams can support such practices.'
The joint NHS England and BMA statement in full:
NHS England and the BMA want to ensure that we deliver on the commitments made in the General Practice Forward View – to deliver fairer distribution of funding. We want to achieve this in a way that does not threaten stability and in a way that does not cause financial uncertainty for practices.
We are now modelling the impact the changes would have on practices in view of other funding flows that are already in train (such as the re-cycling of MPIG and seniority payments and PMS reviews for example).
So, although NHS England and the BMA will now start the detailed negotiations on the new funding formula, we can confirm that we will not seek to implement any changes to the funding formula before 1 April 2018. We believe that this timescale will allow time for better forward planning by practices, better engagement with the profession and patient involvement, if this is required.
It is recognised that, due to the wide diversity of populations served by GP practices, a national formula will never be able to accommodate the workload needs of all practices. We know that a number of practices provide services to patient populations that have characteristics that affect the practice’s costs or workload in a way that cannot be captured through a formula.
Therefore, in parallel to the development of the new national funding formula, we are in the process of developing national guidance for commissioners which will focus on three such population types. This builds on the proposal in the BMA’s Urgent Prescription for General Practice that practices serving atypical populations should be supported through bespoke arrangements. These are:
- university practices,
- unavoidably small and isolated practices, and
- practices with a significant proportion of the patient list who cannot communicate in English.
This guidance will illustrate for commissioners the workload challenges that practices face and guide commissioners to relevant data sources or intelligence to assist them in making decisions regarding sustainable support.