Baroness Gardner of Parkes
To ask Her Majesty’s Government whether NHS university health centres are being disadvantaged by the weighting of the registered list size and the introduction of prevalence quotas for the quality and outcomes framework.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, no. Payments to practices are based on an agreed calculation of health need and on equitable funding. The funding formula recognises patient numbers, with adjustments for the characteristics of the patient population and practice circumstances. The disease prevalence formula in the quality and outcomes framework provides fair rewards to all practices, but with stronger incentives for them to identify and treat patients with the greatest health need.
Baroness Gardner of Parkes
My Lords, I thank the Minister for that Answer, but is he aware that, although some practices in university centres receive support from the university, others are linked to GP practices which run services as a separate contract? Many of those have looked into the finances and found that it is so disadvantageous to them that they are not considering renewing or extending their contracts to supply what I consider to be necessary services. What will the Minister do?
Earl Howe
My Lords, naturally, before preparing myself for this Question, I looked carefully into the way in which university practices are funded. The advice I received is that there is no reason to be concerned on that front. Many university GP practices are funded quite generously. Where they can lose out is over the quality and outcomes framework, which is targeted mainly at elderly patients with long-term chronic conditions, so it is not surprising that university campus practices do not earn the extra money that they could. Nevertheless, we believe that there is no case for making an exception for university practices in the way that they are funded.
Baroness Thornton
My Lords, I congratulate the noble Baroness on getting her head around the system of weighting for payments to GPs for their patients. It contains such gems as,
“An overall weighted listsize for the PCO is generated as the sum of Practice Weighted Listsizes for all Practices in the PCO, and this PCO Weighted Listsize is used together with the PCO Weighted Population”.
I will not go on, but I congratulate the noble Baroness. Given the mental health problems that students often face, is the Minister confident that the system of weighting takes proper account of that medical issue, which is certainly more prevalent than the chronic conditions that he mentioned in a community general practice?
Earl Howe
My Lords, the characteristics of each GP practice will naturally vary according to the patient population. Although a practice situated on a university campus may have higher numbers of patients who require mental health advice and support, there may well be fewer patients in need of other services. I am not aware that there is a particular issue of underfunding of university practices in relation to the mental health burden. As the noble Baroness will know, the QOF was adjusted in 2008 with a two-year time delay, so university practices have had a chance to adjust and prepare for the change.
Lord Foulkes of Cumnock
Are university health centres gearing up to deal with cases of anxiety and depression among students at English universities who wish to go to Scottish universities for a further degree and who find that they will have to pay the full fees, unlike students from other countries in Europe? Is that not a disgraceful, discriminatory proposal by the Scottish Government? Can this Parliament not find a way of outlawing such discrimination?
Lord Patel
Can the Minister say what assessment has been made of the impact of the QOF on the outcomes for patients, whether university patients or otherwise?
Earl Howe
My Lords, there is no doubt that the QOF had many beneficial effects when it first began, and we recognise those. However, there is a general feeling that it needs to evolve and refocus itself more on those things for which it was originally intended, which were to promote quality and better outcomes in patient care.
Baroness Jolly
My Lords, student health does not quite fit the national pattern. Who is currently responsible for public health campaigns within the student body and, with the advent of clinical commissioning groups, is their future assured?
Earl Howe
My Lords, my noble friend will know that public health campaigns and health improvement efforts are currently being commissioned and directed by primary care trusts. That will continue until such time as local authorities take responsibility locally for the public health endeavour.
Lord Richard
My Lords, is the noble Earl aware that very few people in the House understood the Question and, with great respect, even fewer people understood the Answer? Does he not think that his department has an obligation to put out policies that are at least comprehensible to the people whom they are meant to affect?
Earl Howe
I can only apologise to the noble Lord, but he is right that it is a very complex topic. The simplest way in which I can explain the issue around the QOF, which is an element of the way in which GP practices are remunerated, is to say that before we had a situation where practices with large lists but little recordings of those conditions which QOF is aiming at, such as university practices, were receiving relatively higher reward than practices with smaller lists but higher levels of chronic disease and, as a result of the changes, the true prevalence is being used to weight the payments for all practices. The overall effect is to redistribute the total resource for the QOF among GP practices in a much fairer way.