Most believe the impact could not have been predicted, but they want it tackled as a matter of urgency.
GPC deputy chairman Dr Laurence Buckman was a key figure in the negotiating team that devised the quality framework rolled out as part of the new GMS contract in 2004.
‘The profession demanded prevalence, and we did our best to ameliorate the effects of weighting on practices at the bottom by rounding up,’ he said. ‘I’m not omniscient — if you’d asked me if a single practice could have had this impact, I would not have thought it could.’
Unpredicted skew
Dr Buckman said that most people would attribute the skew in quality pay to the ‘law of unintended consequences’.
GPC member Dr Nigel Watson agreed that the impact of single high-prevalence outliers could not have been predicted.
‘It’s always possible to be wise after the event. I don’t think when people talked about this that they could have seen this coming.’
But he said it was ‘ludicrous’ that a care home with high prevalence could leave 97 per cent of GP practices with the same negative weighting on mental health quality pay.
‘Why are they counted as practices at all?’ he asked. ‘If patients from the local area can’t register then it’s not a general practice.
‘You’ve demonstrated why the rounding up and square rooting is a nonsense,’ he said.
Practices should be paid for the work they do, Dr Watson added. He said out that GPs ‘treat patients, not square roots’ and should be paid in direct proportion to the prevalence of disease at their practice.
‘If you look at how statistics usually work, you discount 5 per cent at the top and 5 per cent at the bottom, and look only at the ones in the middle. That’s what should happen here.’
Unfair domain
Dr Trevor Mills, a GP and professional executive committee chairman in Nottingham, said the mental health domain was doubly unfair because of ‘woolly’ definitions about who to include on registers that were used for 2004/5 and 2005/6.
‘Some practices have been putting almost anyone on there,’ he said.
He said the square rooting of prevalence was also debatable: ‘There is a degree of unfairness there. You do a lot of work and are not getting paid properly.
‘With any performance management system there will be something wrong, but I would think there must be a better way.’
He said he would like to see weighting based on true prevalence, particularly because his practice was ‘above average on everything’.
GPC negotiator Dr Richard Vautrey admitted the system ‘needs to be looked at’.
‘We have known that some practices have different make-ups from others, but an effect of this type should not occur,’ he said.
