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Primary Care Scrutiny under the Five Year Forward View – Part 2
Funding and Commissioning
The House of Commons health committee has launched an inquiry into primary care which includes scrutiny of GP pay and workload. The inquiry, which launched at the end of July, will also look at issues including GP recruitment, patient access and the future models of general practice described in the Five Year Forward View. It will look to review:
- The quality and standards of care for patients
- Demand and access (including out-of-hours access and proposals for seven-day access)
- Funding (including local and national distribution of resourcing)
- Future models of care, as piloted by vanguards
- Workforce: current and future challenges (including recruitment, retention, training, skill mix, contractual models, workload and pay)
Announcing the inquiry, which will look at the evidence later this year, the committee said: ‘The aim is to consider whether the Department of Health and its arms’ length bodies have the plans and policies in place now to ensure that high quality care is consistently available to patients at the point of need.’
This article, the second in a series of three, will address the next two areas which are funding & resources and commissioning, and what they mean for practices.
Funding – Is it being allocated equitably?
Last year, the Department of Health (the Department) and NHS England changed the way that they allocated health funding to local commissioners. The Department and NHS England prioritised who they would maintain the financial stability of local health economies, but this meant that they made very slow progress towards ensuring that all areas received their fair share of the available funding. Around two-fifths of clinical commissioning groups (CCGs) and three-quarters of local authorities were receiving allocations more than 5% above or below what would be their defined share. This had consequences for financial sustainability with 95% of CCGs receiving less than their defined share of funding. The National Audit Office calculated that, if the slow pace of change were to continue, it would take around 80 years for all local commissioners to get close to their target funding allocations!
One of the main objectives of the funding formula is to support the reduction of health inequalities, yet the Department and NHS England have only limited evidence on how best to make adjustments for this purpose. NHS England also has more work to do on tackling inaccuracies in GP list data, which are a key determinant in calculating an area’s fair share of funding.
How does the primary care funding formula work?
NHS England has currently improved the funding formula for CCGs, which is based on more detailed data. However, these improvements have not been made for primary care. NHS England did not seek input from the Advisory Committee on Resource Allocation until three months before it had to make decisions about primary care allocations and there was insufficient time to improve the formula. As a result, NHS England’s approach for primary care allocations to area teams for 2014-15 and 2015-16 was heavily based on what the Department had done previously for primary care trusts and is regarded as interim. The Department have recommended that NHS England should improve the primary care funding formula in time for the next round of funding allocations for 2016-17, with early input from the Advisory Committee on Resource Allocation.
What are the benefits of Co-commissioning?
NHS England is responsible for direct commissioning of services outside the remit of clinical commissioning groups, such as primary care, public health, offender health, military and veteran health and specialised services. Last year, NHS England invited CCGs for expressions of interest to take on an increased role in the commissioning of GP services. The intention was to give CCGs more influence over the wider NHS budget and enable local health commissioning arrangements that can deliver improved, integrated care for local people, in and out of hospital.
The benefits of co-commissioning for the public and patients include:
- Improved access to primary care and wider out-of-hospitals services, with more services available closer to home
- High quality out-of-hospitals care
- Improved health outcomes, equity of access, reduced inequalities
- A better patient experience through more joined up services
There are three co-commissioning models that CCGs can take forward which include full delegated responsibility for commissioning the majority of GP services, joint commissioning responsibility with NHS England, and greater involvement in GP commissioning decisions.
What about conflicts of interest?
There was a strong response from CCGs wishing to take on greater commissioning responsibility for GP services and in this financial year over 70% of CCGs have taken on an increased role in the commissioning of GP services. CCGs manage conflicts of interest as part of their day-to-day activities. Effective handling of such conflicts is crucial for the maintenance of public trust in the commissioning system. Importantly, it also serves to give confidence to patients, providers, parliament and tax payers that CCG commissioning decisions are robust, fair, transparent and offer value for money. However, the CCGs commission services should always aim to reduce health inequalities in access and outcomes of healthcare services, and integrate services where this might reduce health inequalities.
In my next article I will address the final two areas which are future models of care; and workforce, including the current and future challenges.
The House of Commons health committee is asking that anyone with an interest in the problems and opportunities facing primary care submits a maximum of 3,000 words to the inquiry by 3 September 2015.
Alison Lowerson – QCS Expert GP Practice Manager Contributor