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CCG funding could be based on population age, not deprivation, says Lansley

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3391 (Published 14 May 2012) Cite this as: BMJ 2012;344:e3391
  1. Helen Jaques, news reporter
  1. 1BMJ Careers
  1. hjaques{at}bmj.com

The funding allocated to England’s new clinical commissioning groups (CCGs) could be based on the age of their patient population rather than levels of deprivation, the health secretary, Andrew Lansley, has suggested.

Speaking at a conference for CCG leaders in London last month, Lansley said that age is the principal determinant of healthcare need and could drive the allocation of funding to CCGs. The funding will be determined by the NHS Commissioning Board and the Advisory Committee on Resource Allocation, an independent expert body, which will look at factors in a CCG’s population data that are likely to give rise to demand for NHS services. “What is likely to make the biggest difference is elderly populations who are not in substantial deprivation,” said Lansley.

He told the conference, “So what should happen—and the advisory committee will do this, I won’t do it—is that the number crunching should get progressively to a greater focus on what are the actual determinants of health need.

“For you [CCGs], the money they give you will be strictly with the objective of trying to distribute resources so that wherever you are in the country you should broadly have resources consistent with ensuring equivalent access to NHS services nationwide.”

Local authorities, which will be in charge of public health from April next year, will receive variable funding on the basis of levels of disease and deprivation but “with a direct expectation that the money is spent on trying to deliver population health improvement,” he added.

Currently, allocation of resources to primary care trusts is based on the relative need of their populations and on changes in national and local priorities.

A key element in this calculation is the weighted capitation formula, which calculates how much money a trust should receive on the basis of the age distribution of its population; the additional need of the population above that accounted for by age, as determined by factors such as socioeconomic characteristics and population health status; and any unavoidable geographical variations in the cost of providing services.

However, although this approach treats age as the primary factor, it penalises regions with many older people but a low level of deprivation, such as the Fylde coast (around Blackpool) and Eastbourne, said Lansley.

“The way in which the formula for distribution resources to primary care trusts has worked in the past, there was a significant element that was based around deprivation, essentially the proportion of people on income support,” he said. “[This approach] is not irrelevant from the point of view of health need but was more relevant to very particular aspects of certain kinds of health need and in particular public health requirements.”

From April 2013 primary care funding will be split between local authorities and CCGs, with local authorities responsible for spending this money on public health and CCGs in charge of commissioning services.

In February the health department announced the baseline funding estimates for emerging CCGs for the 2012-13 financial year, which were based on funding to primary care trusts for 2010-11, uplifted to 2012-13 levels.

According to the estimates a total of £64bn (€80bn; $102bn) will be available to fund CCGs’ responsibilities that are based on their patient lists, such as prescribing costs and out of hours primary care, and £7bn will be available for CCGs’ “geographical” responsibilities, such as care for unregistered populations and charge exempt overseas visitors.

Actual allocations will depend on the final configurations of CCGs and on final decisions on the balance of funding for nationally and locally commissioned services, the health department has said, so the CCG baseline figures need to be “treated with caution.”

Notes

Cite this as: BMJ 2012;344:e3391