Service Categorisation Essential –must do Additional –Preferential right (opt-outs available) Enhanced –Directed (DES) –National (NES) –Local (LES) Global Sum

Carr-Hill formula Weighted capitation methodology: –Age/sex –Nursing/residential homes –List turnover –Additional needs (deprivation) –Market forces (Staff costs ) –Rurality

Calculation Two stages – by PCT then by practice –PCT normalising factor is average weight –PCT population normalised annually EXETER will perform calculation –Based on practice registration data –Ensure practice information is timely/accurate

PCT normalising factor

Carr-Hill weighting

Determination Global sum determined on 1 st day of quarter (eg 01 April 2004) –Contract discussions based on indicative figures Indicative figures make assumptions –Nursing home patients –Temp residents –List 01/04/03

Global Sum Equivalent (GSE) Baseline data – year to 30/06/03 –Take account of GP/staff vacancies –Practice mergers/splits Final GSE 01 April 2004 –Adjust for list size change –Uplift to 2004/05 prices

Correction Factor (CF) Compare Final GSE to GSC: If Final GSE > GSC, the difference is the CF

MPIG (wrong!)

MPIG (right!)

Quality Framework Points make prizes maximum –2004/05 £75/point (for average practice) –2005/06 £120/point (for average practice) Weighted by relative list size –crude list size not Carr-Hill weighted Disease prevalence factor –adjusts point value in each clinical domain

Quality Framework (cont.) Preparation payments (QPrep) –03/04 - £9,000 (for average practice) –04/05 - £3,250 (for average practice) Aspiration payments –For 04/05, aspiration payments are 1/3 of total –From 05/06, aspiration is 60% of prior years achievement Achievement payments –balance of income on outcome –04/05 achievement paid by end April 05

Quality Framework (cont.) Risk managed by NHS Bank –Funding to support approx. 74% of points in 04/05 –Risk shared by high-achieving PCTs, after NHS Bank support except Local variations to QOF through PMS –PCTs need to make local risk management arrangements –ie. no NHS Bank support