Letters New commissioning formula

Authors’ reply to Beerstecher and Peake and colleagues

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.d8184 (Published 04 January 2012) Cite this as: BMJ 2012;344:d8184
  1. Jennifer Dixon, director1,
  2. Peter Smith, professor2,
  3. Martin Bardsley, head of research1
  1. 1The Nuffield Trust, London W1G 7LP, UK
  2. 2Imperial College Business School and Centre for Health Policy, London SW7 2AZ, UK
  1. jennifer.dixon{at}nuffieldtrust.org.uk

Beerstecher asks why the historic healthcare costs of individual patients were not included in the person based formulas we developed for allocating resources to general practices for commissioning.1 2 Their inclusion would indeed have led to significant improvements in predictive power. However, their use was precluded because of the wish of the purchaser not to create a perverse incentive to increase expenditure in one year in order to attract higher funding in future years.

Peake and colleagues are concerned about the accuracy of the national tariff in reflecting the costs actually incurred by hospitals for the care of individual patients.3 The use of actual costs would indeed have given a more accurate picture of cost drivers. However, the purpose of the formula was to model the expenditure needs of GP commissioners and not necessarily the actual costs borne by providers. Therefore the use of the tariff was the correct approach in this study.

So these issues are not shortcomings of our analysis: they reflect the use to which the formula will be put.


Cite this as: BMJ 2012;344:d8184


  • Competing interests: None declared.