Cornwall GP Practice earnings 2013-14

Table 1 is a summary of the key findings for Cornwall, extracted from recently published National Practice Earnings Data.                           

link to HSCIC data

TABLE 1 : Cornwall Practice Earnings and MPIGs 2013-14

Practice NameContract TypeDispensing PracticeNumber of  Patients (Last Known Figure)Number of Weighted Patients (Last Known Figure)Average Payment per Registered PatientAverage Payment per Weighted PatientMPIG Correction Factor
Millbrook SurgeryGMSNo2,6312,628£127.12£127.26£29,319
Churchfield PracticeGMSYes3,2343,739£140.46£121.49£6,801
Camelford Medical CentreGMSYes2,9413,496£144.95£121.93£17,558
Clinton Road SurgeryGMSNo4,1144,442£118.99£110.20£17,584
Trevithick SurgeryGMSNo4,6584,951£129.38£121.73£32,972
Middleway SurgeryGMSNo6,1906,637£119.80£111.74£25,922
Meneage Street SurgeryGMSNo6,0976,207£113.64£111.62£26,194
Port View SurgeryGMSNo6,5376,451£116.18£117.73£28,134
Phoenix SurgeryGMSNo5,9366,080£124.15£121.20£28,824
Westover SurgeryGMSNo8,3927,760£102.95£111.34£55,505
Woodland Road SurgeryGMSNo7,6387,991£114.76£109.69£0
The Park Medical CentreGMSNo7,2887,545£126.89£122.56£19,359
St Keverne Health CentreGMSYes2,8983,607£327.21£262.92£1,282
Polkyth SurgeryGMSNo9,4259,162£104.43£107.43£9,476
Harris Memorial & Lanner SurgeriesGMSYes5,3295,745£188.72£175.07£19,752
Falmouth Health CentreGMSNo8,7168,568£119.59£121.65£64,700
Roseland SurgeriesGMSYes3,6774,190£278.24£244.16£45,759
Mevagissey SurgeryGMSYes5,0225,815£213.31£184.23£19,806
The Rame Group PracticeGMSNo9,6309,711£121.36£120.35£72,336
Homecroft SurgeryGMSYes6,1726,509£188.04£178.30£52,187
Cape Cornwall SurgeryGMSYes4,7375,334£239.47£212.65£4,167
Fowey River PracticeGMSYes7,2838,248£158.07£139.57£24,087
Isles Of Scilly Health CentreGMSYes2,4042,052£454.73£532.70£0
Brannel SurgeryGMSYes4,7904,943£244.22£236.68£23,333
Quay Lane SurgeryGMSYes4,4214,630£275.96£263.52£57,397
Pensilva Health CentreGMSYes4,5295,062£264.84£236.97£7,710
Perranporth SurgeryGMSYes7,1267,565£176.61£166.37£18,465
Manor SurgeryGMSNo11,59812,645£124.35£114.05£0
Stratton Medical CentreGMSNo11,34311,856£121.15£115.91£10,334
Trescobeas SurgeryGMSYes9,2459,225£151.40£151.73£51,776
Bodriggy Health CentreGMSNo10,49810,943£136.67£131.11£8,462
Carnon Downs SurgeryGMSYes5,2656,030£269.41£235.22£9,937
Wadebridge & Camel Estuary PracticeGMSYes7,5147,634£192.24£189.21£68,793
Narrowcliff SurgeryGMSNo12,08111,956£121.45£122.72£17,024
Praze SurgeryGMSYes5,4545,827£270.44£253.12£0
Chacewater And Devoran SurgeriesGMSYes5,5966,048£263.60£243.89£42,045
Old Bridge SurgeryGMSYes9,45611,318£165.83£138.54£0
Stillmoor House Medical PracticeGMSYes10,63011,433£148.41£137.98£0
St Agnes & Mount Hawke SurgeriesGMSYes7,9818,707£201.11£184.33£0
Rosedean House SurgeryGMSYes8,6769,272£203.17£190.12£28,672
Marazion SurgeryGMSYes6,9687,762£248.70£223.26£15,968
Mullion & Constantine Group PracticeGMSYes7,8149,071£228.63£196.95£57,034
Carnewater PracticeGMSYes11,20512,196£171.79£157.83£41,584
Helston Medical CentreGMSYes13,08713,714£158.42£151.18£0
Oak Tree SurgeryGMSYes11,02212,067£193.36£176.62£5,286
Three Spires Medical PracticeGMSNo14,34314,482£172.58£170.92£26,474
The Clays PracticeGMSYes10,89311,499£243.00£230.19£30,691
Launceston Medical CentreGMSYes17,36818,676£165.60£154.00£0
Petroc Group PracticeGMSYes16,12117,517£219.16£201.69£22,954
Tamar Valley HealthGMSYes16,57817,890£225.29£208.76£38,393
Cardrew Health CentrePMSNo2,4592,271£0.56£0.60£0
Neetside SurgeryPMSNo3,8484,012£140.41£134.69£0
Morrab SurgeryPMSNo6,1326,357£124.93£120.52£0
Sunnyside SurgeryPMSNo6,1746,644£122.21£113.57£0
Penalverne SurgeryPMSYes5,1455,561£163.89£151.64£0
Lostwithiel Medical PracticePMSYes4,7485,197£180.69£165.08£0
Rosmellyn SurgeryPMSNo6,8356,958£128.76£126.47£0
The Alverton PracticePMSNo6,1326,567£163.33£152.52£0
Wheal Northey SurgeryPMSNo7,9288,141£144.69£140.91£0
Veor SurgeryPMSNo8,5239,645£140.30£123.97£0
Bottreaux SurgeryPMSYes4,9395,725£259.57£223.93£0
Pool Health CentrePMSNo11,64611,642£130.93£130.98£0
Saltash Health CentrePMSNo13,01412,243£121.62£129.27£0
The Stennack SurgeryPMSNo12,84813,295£144.23£139.39£0
Newquay Health CentrePMSNo16,08914,732£119.50£130.51£0
Port Isaac PracticePMSYes8,4679,257£249.24£227.98£0
Probus & Grampound SurgeriesPMSYes8,5039,184£281.49£260.61£0
Lander Medical PracticePMSNo15,77815,478£162.75£165.90£0
Penryn SurgeryPMSYes17,45816,750£166.75£173.80£0

Totals   average559,217586,495£169.93£162.03


Commentary on Table 1

PMS earnings varied between £99.1 – 138.2 per weighted patient. For GMS practices, earnings are generally lower, and varied between £90.4-117.6 per weighted patient. There are 2 outlying practices, Isles of Scilly Health Centre, which provides 24 hour and other exceptional care, and Cardrew HC, a walk-in clinic set up under the equitable access scheme, whose payments are incomplete.
Payments for premises, seniority and prescribing (especially in dispensing practices) can fluctuate quite a lot. Premises payments are usually cost-rent or notional rent. Cost rent reimbursement depended on the facilities at the premises, and was dependent on interest rates prevalent at the time of initial contract (reflecting the likely cost of the mortgage taken out by the practice at that time. Notional rents are determined by the District Valuer, reflecting the market rent value of the premises. Seniority payments depend on the number of senior doctors in any practice and are usually passed straight on to the senior doctor involved via partnership agreements. Prescribing payments will be much higher in dispensing practices. So in Table 2 we have removed these 3 payments from practice incomes and recalculated earnings per patient.

Table 2. Cornwall GP practice earnings, excluding seniority, premises and dispensing

Practice NameContract TypeNumber of Registered Patients (Last Known Figure)Number of Weighted Patients (Last Known) Payments per patient, excluding seniority, premises, prescribing Payments per weighted patient, excluding seniority, premises, prescribing 
Millbrook SurgeryGMS2,6312,628105.24105.36
Churchfield PracticeGMS3,2343,739106.2991.93
Camelford Medical CentreGMS2,9413,496117.4098.76
Clinton Road SurgeryGMS4,1144,442102.9795.36
Trevithick SurgeryGMS4,6584,951109.46102.99
Middleway SurgeryGMS6,1906,637105.0397.96
Meneage Street SurgeryGMS6,0976,207101.3699.56
Port View SurgeryGMS6,5376,45197.2998.58
Phoenix SurgeryGMS5,9366,080116.14113.39
Westover SurgeryGMS8,3927,76090.9798.38
Woodland Road SurgeryGMS7,6387,991103.0398.47
The Park Medical CentreGMS7,2887,545108.70105.00
St Keverne Health CentreGMS2,8983,607114.6192.09
Polkyth SurgeryGMS9,4259,16290.7893.38
Harris Memorial & Lanner SurgeriesGMS5,3295,745101.7594.39
Falmouth Health CentreGMS8,7168,568108.20110.07
Roseland SurgeriesGMS3,6774,190118.89104.32
Mevagissey SurgeryGMS5,0225,815126.29109.08
The Rame Group PracticeGMS9,6309,711110.38109.46
Homecroft SurgeryGMS6,1726,509109.80104.11
Cape Cornwall SurgeryGMS4,7375,334123.15109.36
Fowey River PracticeGMS7,2838,248121.34107.14
Isles Of Scilly Health CentreGMS2,4042,052351.22411.44
Brannel SurgeryGMS4,7904,94399.4096.33
Quay Lane SurgeryGMS4,4214,630109.02104.11
Pensilva Health CentreGMS4,5295,062103.0992.24
Perranporth SurgeryGMS7,1267,565124.81117.57
Manor SurgeryGMS11,59812,645109.45100.39
Stratton Medical CentreGMS11,34311,856102.6198.17
Trescobeas SurgeryGMS9,2459,225114.87115.12
Bodriggy Health CentreGMS10,49810,943116.07111.35
Carnon Downs SurgeryGMS5,2656,030107.6594.00
Wadebridge & Camel Estuary PracticeGMS7,5147,634116.92115.08
Narrowcliff SurgeryGMS12,08111,956104.53105.62
Praze SurgeryGMS5,4545,827102.4295.86
Chacewater And Devoran SurgeriesGMS5,5966,048109.38101.21
Old Bridge SurgeryGMS9,45611,318118.7599.21
Stillmoor House Medical PracticeGMS10,63011,433102.0994.92
St Agnes & Mount Hawke SurgeriesGMS7,9818,707116.60106.88
Rosedean House SurgeryGMS8,6769,272110.34103.25
Marazion SurgeryGMS6,9687,762109.3298.14
Mullion & Constantine Group PracticeGMS7,8149,071136.42117.52
Carnewater PracticeGMS11,20512,196108.6099.77
Helston Medical CentreGMS13,08713,714109.39104.40
Oak Tree SurgeryGMS11,02212,067104.2495.22
Three Spires Medical PracticeGMS14,34314,482102.67101.68
The Clays PracticeGMS10,89311,49997.9492.78
Launceston Medical CentreGMS17,36818,67697.2090.39
Petroc Group PracticeGMS16,12117,517108.85100.17
Tamar Valley HealthGMS16,57817,890101.9594.47
Cardrew Health CentrePMS2,4592,2710.560.60
Neetside SurgeryPMS3,8484,012126.49121.33
Morrab SurgeryPMS6,1326,357105.65101.92
Sunnyside SurgeryPMS6,1746,644106.6499.10
Penalverne SurgeryPMS5,1455,561128.15118.57
Lostwithiel Medical PracticePMS4,7485,197118.72108.47
Rosmellyn SurgeryPMS6,8356,958111.91109.93
The Alverton PracticePMS6,1326,567147.98138.19
Wheal Northey SurgeryPMS7,9288,141118.69115.59
Veor SurgeryPMS8,5239,645126.09111.42
Bottreaux SurgeryPMS4,9395,725134.83116.32
Pool Health CentrePMS11,64611,642112.74112.79
Saltash Health CentrePMS13,01412,243104.28110.85
The Stennack SurgeryPMS12,84813,295119.25115.25
Newquay Health CentrePMS16,08914,732106.55116.36
Port Isaac PracticePMS8,4679,257134.56123.08
Probus & Grampound SurgeriesPMS8,5039,184124.12114.92
Lander Medical PracticePMS15,77815,478103.57105.58
Penryn SurgeryPMS17,45816,75097.29101.40


Figure 1 shows the data from table 2, with GMS and PMS practices ranked separately.

Commentary on table 2 and figure 1
Even after removing some of the “random variation” provided by premises seniority and prescribing payments, practice earnings still vary between £90.1 and £136.42, unweighted, after excluding exceptions Cardrew Practice and Isles of Scilly HC. Figure 1 shows the data from table 2, with GMS and PMS practices ranked separately. This shows clearly that PMS causes the biggest variation in adjusted practice earnings. Despite this, there are plans to remove MPIG from GMS practices over a 7 year period, which will obviously increase inequality in practice earnings as we will see in Table 3 and Figure 2.

What is the potential effect of MPIG removal?
Table 3 and Figure 2 show the effects of that reduction on payments per patient and per weighted patient.

Table 3  Cornwall GMS practices, potential effect of the removal of MPIG

Practice NameNumber of Patients Number of Weighted Patients Payments per patient, excluding seniority, premises, prescribing Payments per weighted patient, excluding seniority, premises, prescribing Payments per patient, excluding seniority, premises, prescribing and MPIGPayments per weighted patient, excluding seniority, premises, prescribing and MPIG
Polkyth Surgery9,4259,16290.7893.3889.7792.35
Westover Surgery8,3927,76090.9798.3884.3591.23
Launceston Medical Centre17,36818,67697.2090.3997.2090.39
Port View Surgery6,5376,45197.2998.5892.9994.22
The Clays Practice10,89311,49997.9492.7895.1290.11
Brannel Surgery4,7904,94399.4096.3394.5291.61
Meneage Street Surgery6,0976,207101.3699.5697.0695.34
Harris Memorial & Lanner Surgeries5,3295,745101.7594.3998.0590.95
Tamar Valley Health16,57817,890101.9594.4799.6492.33
Stillmoor House Medical Practice10,63011,433102.0994.92102.0994.92
Praze Surgery5,4545,827102.4295.86102.4295.86
Stratton Medical Centre11,34311,856102.6198.17101.7097.29
Three Spires Medical Practice14,34314,482102.67101.68100.8299.85
Clinton Road Surgery4,1144,442102.9795.3698.6991.41
Woodland Road Surgery7,6387,991103.0398.47103.0398.47
Pensilva Health Centre4,5295,062103.0992.24101.3990.72
Oak Tree Surgery11,02212,067104.2495.22103.7694.78
Narrowcliff Surgery12,08111,956104.53105.62103.12104.20
Middleway Surgery6,1906,637105.0397.96100.8494.05
Millbrook Surgery2,6312,628105.24105.3694.1094.21
Churchfield Practice3,2343,739106.2991.93104.1990.11
Carnon Downs Surgery5,2656,030107.6594.00105.7792.35
Falmouth Health Centre8,7168,568108.20110.07100.78102.52
Carnewater Practice11,20512,196108.6099.77104.8996.36
The Park Medical Centre7,2887,545108.70105.00106.05102.43
Petroc Group Practice16,12117,517108.85100.17107.4298.86
Quay Lane Surgery4,4214,630109.02104.1196.0491.71
Marazion Surgery6,9687,762109.3298.14107.0396.08
Chacewater And Devoran Surgeries5,5966,048109.38101.21101.8794.25
Helston Medical Centre13,08713,714109.39104.40109.39104.40
Manor Surgery11,59812,645109.45100.39109.45100.39
Trevithick Surgery4,6584,951109.46102.99102.3996.33
Homecroft Surgery6,1726,509109.80104.11101.3496.09
Rosedean House Surgery8,6769,272110.34103.25107.04100.16
The Rame Group Practice9,6309,711110.38109.46102.87102.01
St Keverne Health Centre2,8983,607114.6192.09114.1691.73
Trescobeas Surgery9,2459,225114.87115.12109.27109.51
Bodriggy Health Centre10,49810,943116.07111.35115.27110.58
Phoenix Surgery5,9366,080116.14113.39111.28108.65
St Agnes & Mount Hawke Surgeries7,9818,707116.60106.88116.60106.88
Wadebridge & Camel Estuary Practice7,5147,634116.92115.08107.76106.06
Camelford Medical Centre2,9413,496117.4098.76111.4393.74
Old Bridge Surgery9,45611,318118.7599.21118.7599.21
Roseland Surgeries3,6774,190118.89104.32106.4493.40
Fowey River Practice7,2838,248121.34107.14118.03104.22
Cape Cornwall Surgery4,7375,334123.15109.36122.27108.58
Perranporth Surgery7,1267,565124.81117.57122.22115.13
Mevagissey Surgery5,0225,815126.29109.08122.35105.67
Mullion & Constantine Group Practice7,8149,071136.42117.52129.12111.23
Isles Of Scilly Health Centre2,4042,052351.22411.44351.22411.44

Figure 2 show Table 3 data in graphical form.

Figure 2. what would happen to Cornish GMS practice incomes if MPIG was withdrawn

Comment on Table 3 and Figure 2 The higher earners tend to have larger MPIGs and will therefore tend to lose more. This withdrawal is planned to take place gradually over 7 years. If a reduction in income inequity was intended, then it would be more sensible to increase the income of the lower earners who tend to have little or no MPIG. Peter McCartney, retired GP, Bristol

The Local View from Dr Mark McCartney, GP Pensilva HC, Cornwall:
The NHS payments data from Cornish practices makes interesting reading, but requires some understanding of the background before coming to any conclusions Firstly, the raw data is taken (like all the national figures) from a full financial year - but in isolation this does not take account of late payments, such as final QOF payments relating to performance from the previous year, or even financial clawbacks connected with previous years (eg refund of seniority overpayments). We know that recently NHS payments have been arriving at practices much later than previously and on occasions practices have sometimes struggled to understand what some payments relate to. Cornwall has a history of quality and innovative practice and under the old national GMS contract GPs were encouraged to invest in their practice staff, through a scheme where two thirds of staff costs were reimbursed. There was much variation in uptake of this, which in part reflects the range of MPIG payments which were required to support and encourage some practices through the transition to the new GMS contract. It is possible that payments to support schemes that arose during the old fund holding system also found their way into the MPIG balancing arrangements. Cornwall's unique geography, rurality and tourism also required GPs to provide more services locally. For example many practices provide phlebotomy and leg ulcer clinics which are not necessarily specified as core services in the current contract. There is also the issue of holidaymakers, who attracted a fee as "temporary residents" when treated under the old contract. This is a major issue for Cornwall, and the budget "disappeared" into the global sum in 2004, never apparently to be reviewed or monitored. "Rural practice payments" were a small additional sum that practices received for rurality, which also went into the global sum to be recalculated under the Carr Hill formula, but also not monitored or reviewed. Capitation (global sum) payments are the main source of practice NHS income, but the other main sources are for quality (QOF) and national or local enhanced services. There has been variable uptake by practices for these other services, which may account for some of the variation in figures. Looking more closely at the Cornwall figures, it is clear that PMS contracts are attracting more NHS money than GMS. It would be useful to know what additional services these practices are providing for the additional funds. The loss of MPIG to GMS practices is only going to accentuate this difference. Rame and Westover practices face losing around £7 per weighted patient, while Quay Lane will lose over £12 Even when premises payments are removed there does not seem to be any obvious association between the level of NHS payments and the provision of branch surgeries. The running costs of branch surgeries would include additional staff costs and these tables add no understanding to the financial processes required to support providing these services. The data reveals many inequalities in NHS payments which are not easily explained in terms of rurality, deprivation, premises or general investment. However at a time when practices are struggling to meet increasing demands it seems unwise to destabilise the recruitment and retention situation further by removing MPIG and seniority, as the government plans to do. It would be wiser to adopt a more cautious long term approach by targeting financial uplifts to those practices that are under resourced and struggling to meet the quality and safety standards expected in 2015. In summary for Cornwall 1. Loss of MPIG will seriously affect at least three practices 2. PMS practices receive higher NHS payments per weighted patient 3. It has not been possible to assess if there is any correlation between funding levels and the provision of branch surgeries. Information about premises and branch surgeries may be included in future analyses 4. Premises funding is disproportionally skewed towards only three or four practices 5. Phasing out seniority payments may have some unintended consequences, although these payments are usually kept by the individual GPs and not used to fund practice services. 6. It has not been possible to include any analysis of the impact of dispensing payments Further comment and analysis from local GPs would be very welcome. The figures would be easier to understand with more information on practice expenses. Are practices prepared to invest more in their staff to generate extra NHS income, or are they more inclined to sacrifice costs to generate savings and reduce the fall in profits that appear to be occurring everywhere in UK General Practice?