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Funding Changes from April 2009

May 2009

The agreed changes for 2009/10 are designed to move towards a more equitable system of funding of core services provided by practices. The Doctors and Dentist Review Body (DDRB) recommended a gross increase of 2.29% in order to allow an average increase in GMS practitioners’ net income of 1.5%.

The BMA and NHS employers agreed a complicated formula to allocate the pay increase between the global sum and the correction factor. As a result the pay changes will be as follows:-

Global Sum and Correction Factor Payments

  • Every GMS practice will receive a national minimum uplift of 0.70% to their global sum equivalent (global sum plus MPIG correction factor).
  • The global sum will be increased from £56.20 in 2008/09 to £63.21 in 2009/10. However the agreed formula means that practices will receive a higher increase in their global sum, but their correction factor will reduce.
  • The cost to opt out of ‘out of hours’ remains at 6% of the global sum, however as the global sum will be increasing, the cost to opt out will increase.

Quality and Outcomes Framework

  • The value of the quality and outcome framework points will increase by 1.74% from £124.60 in 2008/09 to £126.77 in 2009/10.
  • The square root mechanism that is applied to the calculation of prevalence will be replaced with true prevalence. On 1st April 2009, the square rooting will be discontinued and on the 1st April 2010 true prevalence will be used to calculate QOF. This has resulted in many practices expecting to see a drop in their QOF income together with the loss of income due to the national survey results!

Enhanced Services

  • There will be an increase of 1.74% in enhanced services payments.

Implications for PMS Practices

The above agreement applies to GMS contracts. The department of health have said that while PMS and APMS contracts are locally negotiated, PCTs need to demonstrate that funding decisions between all primary care contractors are fair and equitable and represent value for money.

The department of health have suggested that they expect PCTs to apply the DDRB recommendations to PMS practices in an equitable way to that which is applied to GMS practices. Therefore if a PMS practice is receiving more than the new global sum amount per patient of £63.21 it would not receive more than 0.7% increase.

Examples of pay changes for GMS practices

Practice 1 – Registered List 7,155

  2009/10 2008/09
Global Sum £63.21 x WL 505,870 443,176
Correction Factor 8,195 67,315
Global Sum Equivalent (0.7%) 514,064 510,491
Increase in core funding 3,573  
Percentage Increase 0.7%  
     
Cost to Opt out of ‘OOH’ – 6% (30,352) (26,590)
     
Expected gain/(loss) due to change in QOF Prevalence    
2009/10 665  
2010/11 3,690  

This practices core funding will only increase by 0.7% giving them an increase in income of £3,573. However as the cost to opt out of ‘out of hours’ is 6% of the global sum only, this cost will increase by £3,762, therefore resulting in no uplift to their core funding!

Practice 2 – Registered List 15,611

  2009/10 2008/09
Global Sum £63.21 x WL 960,904 842,736
Correction Factor 0 80,945
Global Sum Equivalent (0.7%) 960,904 923,681
Increase in core funding 37,223  
Percentage Increase 4.02%  
     
Cost to Opt out of ‘OOH’ – 6% (57,654) (50,564)
     
Expected gain/(loss) due to change in QOF Prevalence    
2009/10 (9,892)  
2010/11 (10,797)  

This practices core funding will increase by 4.02% giving then an increase in income of £37,223. The cost to opt out of ‘out of hours’ will increase by £7,090 so overall net increase in core funding will be £30,133. However, will lose £10,000 due to changes in QOF prevalence.

Practice 3 – Registered List 2,621

  2009/10 2008/09
Global Sum £63.21 x WL 170,730 151,781
Correction Factor 0 0
Global Sum Equivalent (0.7%) 170,730 151,781
Increase in core funding 18,949  
Percentage Increase 12.48%  
     
Cost to Opt out of ‘OOH’ – 6% (10,243) (9,107)
     
Expected gain/(loss) due to change in QOF Prevalence    
2009/10 (1,628)  
2010/11 (2,681)  

This practice is one of the few without a correction factor, as a result it will see an increase in core funding of 12.48% giving an increase in income of £18,949. The cost to opt out of out of hours will increase by £1,136.

Jenny Stone