Primary care capitation payments in the UK. An observational study

Abstract

BackgroundIn 2004 an allocation formula for primary care services was introduced in England and Wales so practices would receive equitable pay. Modifications were made to this formula to enable local health authorities to pay practices.Similar pay formulae were introduced in Scotland and Northern Ireland, but these are unique to the country and therefore could not be included in this study.ObjectiveTo examine the extent to which the Global Sum, and modifications to the original formula, determine practice funding.MethodsThe allocation formula determines basic practice income, the Global Sum. We compared practice Global Sum entitlements using the original and the modified allocation formula calculations.Practices receive an income supplement if Global Sum payments were below historic income in 2004. We examined current overall funding levels to estimate what the effect will be when the income supplements are removed.ResultsVirtually every Welsh and English practice (97%) received income supplements in 2004. Without the modifications to the formula only 72% of Welsh practices would have needed supplements. No appreciable change would have occurred in England.The formula modifications increased the Global Sum for 99.5% of English practices, while it reduced entitlement for every Welsh practice.In 2008 Welsh practices received approximately £6.15 (9%) less funding per patient per year than an identical English practice. This deficit will increase to 11.2% when the Minimum Practice Income Guarantee is abolished.ConclusionsIdentical practices in different UK countries do not receive equitable pay. The pay method disadvantages Wales where the population is older and has higher health needs.

Empirically derived weights for GMS capitation payments to General Practitioners

“…As described above, the inclusion of a robust measure of additional health needs, markedly improves predictability [5,8]. Many fall short of the ideal because data on each need variable must be available for all recipients of the service.…”

“…Meanwhile, Behan13 does not suffer from recall bias but may suffer from sampling bias. Weighted-capitation models used in other health systems use much larger, and in some cases population-wide, administrative data, [5,7,8] which overcomes any sampling bias.…”

“…The UK model is the most sophisticated in Europe. It uses multivariate regression techniques to generate patient weighting based on age, gender, additional health needs, local labour costs, rurality, patient list turnover and living in a nursing/residential home [5]. Of these, the inclusion of additional health needs, as measured by chronic illness and area-level mortality, is the most important for predicting patient costs.…”

Impact of the Prevalence of Concordant and Discordant Conditions on the Quality of Diabetes Care in Family Practices in England

“…We obtained demographic data, number of general practitioners per practice, and the Carr-Hill normalized practice weighted list size 15 (used for resource allocation for family practices in England, as it includes a number of adjustments to ensure that resources reflect more accurately the contractor's workload and the unavoidable costs of delivering high-quality care to the local population) from the Health and Social Care Information Center Indicator Portal. 16 We also obtained the Index of Multiple Deprivation (IMD) 17 for the practice postcodes from the Department of Communities and Local Government.…”

Shortage of general practitioners in the NHS

“…Since the NHS was established in 1948, core funding of general practice has been capitation based. 6 However, this model increasingly looks unfit for the 21th century. With activity based funding, general practices would be paid for the work that they do, and practices would take on new work only if the funding met the full costs of providing the service.…”