Multimorbidity measure could lead to fairer GP funding system

GP funding allocation could be improved by using a new measure of multimorbidity, UK researchers have suggested.

Data on multimorbidity could improve accuracy of GP funding allocation (Photo: Martin Prescott/Getty Images)
Data on multimorbidity could improve accuracy of GP funding allocation (Photo: Martin Prescott/Getty Images)

More than half of GP consultations with patients aged over 18 or over are with patients who have multimorbidity, research has shown.

But academics behind the new scoring system - the Cambridge Multimorbidity Score - warn that NHS 'services and policies have failed to respond to the pressures that multimorbidity places on primary and secondary care'.

The academics warn that these pressures are 'driven by the ageing population, by policies that promote rapid access over longer consultations and continuity of care, and by single-disease guidelines and performance targets, which lead to overprescribing without addressing the priorities of the patients themselves'.

The newly-devised scoring mechanism - which considers data across 20 conditions - could provide a basis for more accurate allocation of resources and improve care for patients with multimorbidity, they argue.

Multimorbidity

Research published in CMAJ this week says multimorbidity scores can help doctors target care at patients most likely to benefit from 'a tailored approach to care' - and may be a more effective means of improving care for patients with multimorbidity than 'focusing on the identification of a specific priority problem such as unplanned admissions or frailty'.

The study found that patient case-mix had been shown to explain 'most of the variance in patient costs'. But it added: 'In UK primary care, the funding allocation (Carr–Hill) formula does not account for patient morbidity directly. Scores developed through a transparent process, with “real world” contemporary data and weightings that incorporate a range of key outcomes, should help policy-makers and clinicians to understand and support their use for priority-setting purposes.

'In addition, multimorbidity scores provide an opportunity to capture clinical complexity and to identify what matters most in general practice, for example, by moving away from the UK’s current payment-for-performance QOF incentivisation system, which is based on individual conditions.'

One of the study authors, Professor Martin Roland of the University of Cambridge primary care unit, said: 'The Cambridge Multimorbidity Score can be a useful predictor of future healthcare use, including primary care utilisation, emergency department visits and death and may be of considerable value for policy development and health care priority setting, providing accurate, easy-to-implement ways of optimising healthcare delivery to an ageing population with multiple illnesses.'

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