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Healthcare in a rural setting

January 2005
Board of Science

Appendix A: Extract from the General Medical Service (GMS) contract: investing in general practice
4 Developing human resources and modernising infrastructure
4.23 Supporting practices in rural and remote areas
GPs in rural and remote areas of the UK form a small but essential part of the NHS. The new contract will recognise their specific needs and help ensure they receive proper support:
(i) through the Carr-Hill allocation formula, which includes a specific adjustment for rurality. This takes account of population sparsity and dispersion, and means that rural and remote GPs will benefit in their global sum and the practice weighted population adjustment to quality payments.
(ii) through the powers described in chapter 2 for primary care organisations (PCOs) to employ staff to provide GMS and support practices. The new flexibility for PCO and practice-based salaried options may also be particularly useful in rural and remote areas.
(iii) through funding arrangements that will ensure support for practices in recognition of the extra burdens of being a remote and rural GP, for example extra travel costs to attend PCO-sponsored or PCO-approved training and the continued need to provide out-of-hours care which will be supported by the Out-of-Hours Development Fund. There will be a range of independent contractor and employed options, which will improve upon and replace the current inducement scheme, which will cease on 31 March 2004.
(iv) for immediate care and first responder services. Rural and remote GPs are often more involved in the provision of emergency care outside the setting of their surgery or a local community hospital. This work requires extra training (eg the British Association for Immediate Care provides courses in dealing with emergencies), equipment, resource, commitment and reward. Under the new contract, these services will be commissioned and funded as an enhanced service. PCOs will normally wish to commission such services where land ambulance response times are relatively long or the practice is remote from the nearest appropriate hospital. Practices providing these services will need to ensure relevant practitioners have the necessary skills, for example through attending a BASICS course at least once every five years.
(v) for GPs working for community hospitals and minor injury clinics. Staffing of community hospitals and minor injury services is an integral part of many GP practices, particularly in rural or remote areas. Under the new contract these services will be commissioned and funded from the unified budget or its equivalent in Northern Ireland. A specification for the minor injuries enhanced service provided within a practice will be published shortly in supporting documentation.
(vi) through twinning arrangements. Under the new contract, PCOs will support arrangements to minimise the impact of geographical isolation on all professions in rural and remote areas. The Remote and Rural Areas Resource Initiative (RARARI) in Scotland will examine how twinning arrangements could best support GPs in remote and isolated areas. Lessons learned from this will be implemented throughout the UK. Where twinning is feasible, and supported by the LMC (or its equivalent), the PCO will do its utmost to support
implementation.
4.24 Supporting practices in deprived areas
The new contract will recognise the additional workload involved in providing care in deprived inner city areas through the morbidity factor in the Carr-Hill formula. Underdoctored areas will also gain from the allocation of money on the basis of patient need rather than the number of doctors. Practices will be able to seek to provide a range of enhanced services for the specific needs of their population.
Explanatory notes
Carr-Hill allocation formula
This is a new resource allocation formula and will provide the basis for allocating funds for global sum resources and for quality payments. It takes account of determinants of relative practice workload and costs. The proposed formula includes the following components:
• an adjustment for the age and sex structure of the population, including patients in nursing and residential homes
• an adjustment for the additional needs of the population, relating to morbidity and mortality
• an adjustment for list turnover
• adjustments for the unavoidable costs of delivering services to the population, including a staff Market Forces Factor and rurality.