Funding concerns regarding the new GP practices and health centres
A letter from Dr Laurence Buckman, chairman of the GPs committee, to Mr Ben Dyson
3 April 2008
Dear Mr Dyson
The General Practitioners Committee (GPC) has been closely following the progress of the NHS Next Stage Review, led by Lord Darzi. As you are aware, the interim report of this review gave the commitment that the NHS would establish 150 GP-led health centres in all Primary Care Trusts (PCTs) and 113 new GP practices in the 50 PCTs currently with the poorest provision of primary care. The GPC remains particularly concerned about the procurement of these new services.
The funding for these practices and the health centres will be provided by the £250 million access fund announced in the 2007 Consumer Spending Review. In a letter to Dr Hamish Meldrum, Chairman of BMA Council, Lord Darzi stated that this £250 million would become a recurrent part of PCT funding. I am very pleased to see this commitment to the long-term funding of these new initiatives by the Department of Health.
I understand from your letters to Strategic Health Authorities that indicative funding allocations for new practices have been agreed up to and including the period 2010/11. The GPC is keen to know whether the funding allocations will remain at the 2010/11 level as a minimum into 2011/12 and beyond, and also how the figure for allocated funding of each new practice was reached. Clearly, the success of these new practices will be based on sufficient and consistent funding. I would be grateful if you could provide more information on the future allocation levels to these practices.
The GPC is very concerned about the funding situation for the un-piloted health centres. I understand that only £45 million of the total £250 million access fund is to be allocated to PCTs to fund health centres on a weighted capitation basis. With the expectation that 150 health centres will be established, this means that each will only be allocated £300,000 to deliver the extensive and flexible GP services demanded by the health centre core criteria. This is quite clearly an inadequate figure – new GP practices are to be allocated nearly three times this level of funding in 2010/11. Considering that the Department of Health is requiring every PCT to procure a new health centre regardless of the clinical needs of the local population, it would be very useful to understand how it is expected that these centres will be funded.
The potential destabilisation of existing GP practices, as a result of the new over-capacity that will be introduced in many areas through procurements for new practices and health centres, is a cause of major concern to the Committee. New practices are required, as part of their core criteria service specification, to hold a minimum list size of 6,000 patients, while health centres will also be expected to build a registered list. The movement of patients away from established practices to these new services will entail a reduction in funding for the established practices. This will have a detrimental effect on their ability to provide care for the rest of their patients in the community, thus undermining the intention to improve primary care in the areas of poorest provision.
Despite the requirement to build a list, the new practices and health centres will have no registered patients upon opening. It is therefore likely that the contracts for the new practices and health centres will be priced on a capitation basis according to an aspirational rather than an actual list. The GPC is keen to know how the Department of Health intends to price the contract and recognise the difference between aspirational and actual lists. Given the likelihood of over-capacity, does the Department of Health expect the aspirational list of these new practices and health centres to be fulfilled at the expense of established practices? What contingencies are there to support established practices that have had their funding reduced as a result of patient movement towards new practices? Should the new practices fail to fulfil their aspirational list, and if the contract price does not reflect the actual list size, the GPC (and, we assume, the public) would view these new practices as very poor value for money.
I look forward to receiving your response to our concerns regarding these funding issues. I would also be most grateful if you could pass to the GPC a copy of any letters you send to Strategic Health Authorities or PCTs concerning the procurement of these new services, for our information.
Yours sincerely,
Dr Laurence Buckman