#RememberRural
The Workload Allocation Formula
This is the map that gave RGPAS and the BMA the most concern and surprise about the new contract. The new formula simply failed to reflect the workload and services provided by rural GPs and their teams. As a result, the red dot practices (where practices would lose money) were placed on ‘funding protection’ to avoid cuts of up to 88%.
An expert view: Phil Wilson,
Professor Emeritus, University of Aberdeen, Rural Health & Primary Care.
“The latest workload allocation formula is based on an outdated and unrepresentative sample of practices (the PTI dataset was abandoned as worthless by Scottish Government Health Division in 2013), and relies simply on consultation numbers (or Read codes) per patient as the driver for allocation of funds to practices. Funding allocations are now simply calculated on the basis of patient numbers, age and SIMD scores, and the cost of supply of medical services (higher in rural areas) is now excluded from the formula for reasons that have not been made clear.
Arguably, it is patients in rural and remote areas that are most reliant on their practices to deliver health care. They have no option to register with a nearby practice or attend an A&E department if their practice collapses. Over 90% of practices in the northern Health Boards will be in the income support category. It is rural practices that have the biggest problems recruiting GPs and there are already large swathes of Caithness, Sutherland and the Isles where patients cannot access a doctor without travelling huge distances. ”
An expert view: Roger Strasser AM
Professor of Rural Health
Dean and CEO, Northern Ontario School of Medicine, Canada
“”This situation seems paradoxical. On the one hand, the Scottish government is investing in education, training and service initiatives to improve health in rural and remote areas, and on the other hand the government is undermining these initiatives by undervaluing and demoralising the rural practitioners who are the cornerstone of care…It appears to be a classic example of decisions being made to address issues/concerns in the cities/dense population areas that have unintended negative consequences for people in rural and remote communities. Unfortunately rural practitioners and their communities are left questioning whether these consequences are truly “unintended“.
An expert view: Dr Helene Irvine,
Consultant in Public Health Medicine, NHS Greater Glasgow & Clyde
Member of TAGRA during the SAF Review
(TAGRA = Technical Advisory Group on Resource Allocation)
“The substitution of an earnings protection payment for the excess cost of supply adjustment is drastic and inexplicable. In my view, it was done with insufficient effort to come up with a robust replacement for the adjustment for excess cost of supply. Whilst attending the relevant TAGRA meetings, I noted that far too little time and effort was afforded to studying this aspect. Those present at these meetings will recall that I consistently expressed the view that the excess cost of supply adjustment was historically too generous and argued that case at the meetings and in writing to the TAGRA chair.
However, removing it altogether after so little effort to come up with a replacement is unfair. It means that the rural GPs are bound to be very unhappy with what appears to be ‘on income support’ status where they are vulnerable to reductions in revenue on the grounds that they are being heavily subsidised by an MPIG equivalent. GPs are well aware of the vulnerability of current MPIG funding and will not be assured by statements that they are protected indefinitely, particularly when funding decisions transfer to the heath board or HSCP.”