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Have we given up on rewarding quality?

So, the big question for me in 2014 is whether my re-discovered optimism regarding the funding for the 2014/15 GMS contract was well-founded, or my ingrained cynicism justified. Humbug or hooray?

Just before Christmas, NHS England published proposals for new global funding. MPIG will be phased out over seven years, as previously thought, a number of QOF points will be reallocated, and the global sum will increase from the existing £66.25 per patient to £72.74 for 2014/15, £73.69 for 2015/16, £74.63 for 2016.17, with similar increases up to £78.33 by 2020/21.

The effect of this has been shown on figures we have worked on and that Medeconomics has now published as examples. As we thought, practices with high MPIGs (correction factors) will lose most money. Ironically, these will be the better performing practices; remember, the MPIG was designed to compensate those practices in 2004 who were earning more (providing more services/based in deprived areas) than the Carr-Hill formula could deliver.

In fact, reading the letter from NHS England, the intention is ‘that funding for GP practices will be properly matched to the number of patients they serve and the health needs of these patients’. In other words, there is no distinction being made between those practices that we know are better performing and those that are not. I make this point because the 2004 contract was underpinned by funding quality. Not anymore.

NHS England accepts there will be losers and, in fact, 98 practices - termed ‘outlier’ practices - will lose a lot. These practices, it says, have three options: to collaborate or merge with other practices; make cost savings; or review other commissioning/contract options. Frankly these are silly suggestions.

The first option only works meaningfully if a practice can move into another's premises, otherwise the savings are minimal. Practices have been cutting costs for several years to meet pay freezes and increase costs, to offer the second option shows a woeful lack of insight and understanding.

As for the final option of looking at other commissioning and contract options, NHS England has not shown itself to be particularly helpful since last April; getting anyone to acknowledge an email has proved an achievement in itself.

I am hanging on to my optimism, but I am struggling.

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