You are quite right to demand that the prevalence formula should be reviewed to ensure that it fairly reflects workload (GP, 12 May).
However, I fear the likelihood of this happening is remote. The prevalence formula was implemented with one object in mind: to divert money from the hard-pressed practices with high workloads into practices with very low workloads.
Both the curious biasing of the mean, as described in your article, and the square rooting of the prevalence factor have this effect.One of the reasons given by the members of the GPC for this extraordinary piece of mathematical gymnastics includes the statement that it would be undesirable to create huge disparities in income. Huge disparities in workload are presumably perfectly acceptable in the eyes of the GPC.
Another reason given by one member of the GPC was that practices with high disease prevalences enjoy economies of scale. This is clearly nonsense.
Large practices might enjoy economies of scale. There is no reason why practices with high disease prevalences should enjoy economies of scale.
At a time like the present when we are, by any objective standards, very well paid, it is very difficult to generate any enthusiasm for change, or to rely on any sense of injustice within the profession.
The DoH has signalled its intention to freeze our remuneration.
We can expect a scenario in which our pay declines to a more moderate level.
If we do nothing now, this unfairness will become locked in, permanently disadvantaging practices in deprived areas where recruitment is already virtually impossible.
I really cannot understand why anyone is allowed to get away with this.
Removing it would of course be entirely revenue neutral and would safeguard the income of practices in the poorest areas.
Alan Keith, Rotherham, South Yorkshire.