Doctors in the waiting room
Nigel Williams, 1 February 2013
By Mervyn Stone
The plate on the door is that of the new Secretary of State for Health. The GPs are waiting to be told what they or their CCG (Clinical Commissioning Group) will get for next year’s commissioning. That wait may be over by the New Year but there may be a longer wait to be told why, if it does, the per capita allocation varies so much between GP-practices. These by-now cliff-hanging uncertainties stem from an exchange between the then-new Secretary of State for Health and the chairman of ACRA (the Advisory Committee on Resource Allocation) on 27 September and 11 October 2010.
The chairman wrote mainly about the immediate problems in funding for the transition period to April 2013, but went on to offer the continuing services of his committee for what was to be done from then on:
“I am sure you will also be interested to know that ACRA has progressed its longer-term work to produce a person-based formula. This may be particularly relevant to allocations to GP consortia and we would like to continue to progress this work as an alternative to the current approaches.”
In response, the Secretary of State asked ACRA to continue to advise at least during the transition period, saying that his department’s aim is to publish the first operational allocation for 2013-14 in late 2012 and welcoming advice on four matters relevant to GP-commissioning.
ACRA’s person-based allocation formula was what an 11-strong research team from the Nuffield Trust and partner institutions revealed to British Medical Journal subscribers on November 22 2011. I have published an article that exposes the econometric pretensions of the research that ACRA commissioned. It remains to be seen whether arm’s length thinking has already implemented the constructive alternative that I recommend. That is, a simple extrapolation of recently justified `historical’ costs based on direct assessment of the aggregate health care need of stratified random samples of individuals/patients on GP-practice lists − rather than a prediction of future costs with what I and other statisticians see as an over-complex, assumption-ridden formula − one that is, we believe, unlikely to express any reality accurately enough to be a financial instrument of resource allocation.
(Re-posted from 4th December 2012)
Mervyn Stone is Emeritus Professor of Statistics at UCL and author of the Civitas publication Failing to Figure.