ANNEX B CALCULATING GLOBAL SUM AND MPIG PAYMENTS. v.31/01/04. Introduction. B1. This annex:

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1 CALCULATING GLOBAL SUM AND MPIG PAYMENTS ANNEX B Introduction B1. This annex: (i) (ii) explains the detailed steps involved in calculating the global sum and MPIG illustrates and describes the different spreadsheet tables that LHBs will receive for each contractor along with their allocations in January It uses worked examples to show how each table works. B2. LHB finance departments should read this annex very carefully in order to finalise the construction of indicative contractor budgets and deal with any queries from their contractors. Global sum and MPIG calculation method B3. Table B1 describes each of the steps, the information sources and the calculation method. Annex B Global Sum MPIG Final - 1 -

2 TABLE B1 CALCULATING THE GLOBAL SUM AND MPIG Part Step Activity Information Source/Calculation Method 1. Calculating the global sum 1 Take raw data for each contractor from the Exeter Attribution Data Set and other sources provided by the BSC LHBs will be given a global sum allocation for its GMS practices in February. This will be based on data from the April 2003 Attribution Dataset (ADS). Along with the financial allocation, LHBs will be given their normalised weighted population, their crude population and their normalising factor. The normalising factor is the ratio of the normalised weighted population to the crude population. The normalising factor remains constant throughout the year, and each quarter as the population changes, the crude population should be multiplied by the normalising factor to get the new weighted population. For each quarter, the practice populations should be normalised against this updated LHB weighted population. Practice allocations will be based on the latest quarterly LHB level Exeter ADS information and information provided by the Assembly Annex B Global Sum MPIG Final - 2 -

3 2 Calculate the adjustments for: (i)age and sex of patients on practice list (i) Table B details the age and sex breakdown of the two practices after the numbers of patients in each category have been adjusted to the LHB weighted population. Table C then weights the patients by the relevant age/sex weighting factor, as set out in the SFE. (ii) patients in nursing and residential homes (ii) Table D Nursing and Residential Homes adjustment. Patients in a nursing or residential home receive a weighting of 1.43 compared with other patients that receive a weighting of 1. The nursing and residential homes patient information is planned to be available from the Exeter system. (iii) list turnover for new patients (iii) Table E List Turnover. Patients in their first year of registration at a practice receive a weighting of 1.46 compared with patients not in their first year. The new patient count will be available through the Exeter system. (iv) additional needs (iv) Table F Additional Needs. The measure of standardised limited long-standing illness and the standardised mortality ratio are used to weight the practice population for additional needs. These scores for these will be provided at ward level, and will be Annex B Global Sum MPIG Final - 3 -

4 attributed to practices using the patient postcodes from the Exeter system. (v) staff market forces (vi) rurality 3 Create indices for each adjustment so that they carry equal weight by: (i) Scaling the weighted populations back to derive a share of the LHBs weighted population (v) Table G Unavoidable Costs (MFF). This adjustment takes account of geographical variations in staff costs. The market forces factor (MFF) is determined by estimating the unavoidable variation in employment costs in different parts of the country. Scores for each of the NES zones will be matched to practices using the practice postcode. (vi) Table H Unavoidable Costs (rurality). The distance of the population from a practice and the density of that population influence the costs of delivering GMS services. Information on the distance and density of the population will be provided through the Exeter system. For each of the indices above in Table C to H, the calculated weighted populations of the two practices are normalised back to the weighted population of the LHB (ii) Create an index for each adjustment by dividing the scaled back weighted practice population by the crude practice population Annex B Global Sum MPIG Final - 4 -

5 4 Calculate the Contractor s Weighted Population by applying the six indices simultaneously to the Contractor Registered Population (CRP) and normalising to the LHB weighted population Table I: each of the index listed in Tables B to G are multiplied together to generate the contractor weighting for each practice. This is then multiplied by the raw practice list size to produce the weighted population for each practices and then is normalised back to the LHB s weighted population 5 Calculate the Initial Global Sum by multiplying the Weighted population by 50 per patient in 2004/05, and adding the London weighting adjustment. Table J calculates the initial global sum and correction factor by taking the Normalised Weighted Population from Table I column J and multiplying it by 50. The 50 per patient rate may be subject to amendment in the light of the onformula superannuation indexation increase 6 Calculate the Temporary Patients Adjustment (TPA) an off-formula adjustment. This is described in annex C of the SFE 7 Deduct any monies for additional service and out of hours opt-outs This annual sum is based on a five-year average of costs This deduction is a percentage of the initial global sum which is the addition of steps 5,6 and 7 above 8 The result of this is the contractors Global Sum Annex B Global Sum MPIG Final - 5 -

6 2. Calculating the Global Sum Equivalent 3. Calculating the Correction Factor 9 Extract global sum equivalent fees and allowances plus staff reimbursement data) between 1 st July 2002 and 30 th June 2003 from Exeter System uplifted to 2003/04 prices 10 Calculate adjusted GSE by taking account of: (i) GP vacancies (ii) practice mergers (iii) practice splits (iv) staff vacancies if agreed locally (v) changes in the list size between the GSE data collection period and April 2004 The rules are set out in paragraphs 8-19 of annex E of the SFE 11 Calculate the Global Sum Equivalent (GSE) by uplifting the to 1 st April 2004 value 12 Calculate the correction factor by subtracting global sum from global sum equivalent after taking account of historic opt outs from global sum. If amount is positive, this is the correction factor before adjustment. The next three steps are described in annex D of the SFE For the first calculation in April 2004, LHB s will need to adjust the GSE to take account of list size changes. See annex E MPIG Guidance in the Statement of Fees and Allowances Divide by 12 to give monthly correction Annex B Global Sum MPIG Final - 6 -

7 4. Paying and revising the Global Sum Monthly Payment and Correction Factor factor. This together with the monthly global sum) constitutes the monthly entitlement under the global sum/mpig. 13 Adjust the monthly correction factor where need be to take account of: (i) to take account of practice mergers and splits after 1 st April (ii)to take account of contract termination. These are payable only in respect of number of days for which the contract runs 14 Ensure the payment of the monthly sum and correction factors where need be by the end of each month 15 Revise quarterly the: The rules are set out in paragraphs of the SFE. (i) global sum (expressed monthly) for changes in both composition and size of contractor registered population taking account of mergers and splits.this must be done on the same day for all contractors the 1 st day of each quarter The information to undertake this calculation will be derived from the Exeter system. (ii) Monthly correction factor only to take account of contractor mergers or splits Annex B Global Sum MPIG Final - 7 -

8 16 Revise annually the Temporary Patients Adjustment (TPA) 17 Adjust annually the first Global Sum Monthly Payment of each year to take account of contractors with QOF achievement points of less than 100 in the previous year 18 Uplift annually the price of the registered patient for the calculation of the Global Sum Monthly Payment in line with any changes to the SFE. In accordance with the guidance As set out in the joint John Chisholm/Mike Farrar letter of 30th May 2003, as part of the MPIG deal there will be no uplift in 2005/06 Annex B Global Sum MPIG Final - 8 -

9 Worked example for calculation of indicative contractor budgets B4. This section of the annex illustrates how the method described in the table is put into practice. 12 different spreadsheet table are used. These are as follows: Table A - Converting the raw data for each of the practices into a weighted population for the LHB Table B - The raw data for each of the practices scaled by the weighting factor for the LHB Table C - An adjustment for the age and sex structure of the practice lists Table D - A nursing and residential home index Table E - An adjustment for list turnover Table F - An adjustment for the additional needs of the patients on the practice lists Table G - An adjustment for the unavoidable costs related to location of the practice Table H - An adjustment for the unavoidable costs related to the rurality of the practice Table I - Combining each of the indices the total weighting for each of the practices Table J - Calculating the initial Global Sum monthly payment and the correction factor Table K - Adjusting the initial Global Sum monthly payments to take account of opt-outs Table L - Defining the Historic opt-outs adjustment. B5. Each table is described in turn. B6. It is worth noting that the steps used to produce the weighted population for the contractor follow a similar pattern:(i) the raw data is multiplied by a weighting factor, then (ii) each of contractor lists is scaled back so that the sum of contractor lists is equal to the LHB s weighted population. This scaling process at each of the steps is known as normalisation. It is necessary to ensure there is an equal impact for each of the steps in the formula. For example, without the normalisation process, the impact of the list turnover adjustment may completely dominate all the other adjustments. Annex B Global Sum MPIG Final - 9 -

10 Table A - Converting the raw data for each of the practices into a weighted population for the LHB B7. The weighted population for the LHB is derived by multiplying the most up-to-date raw population of the LHB by the LHB normalising index. B8. The normalising index for each financial year is calculated by the Assembly from data underpinning the allocations. It is derived by dividing the weighted population for the LHB by the raw population for the LHB. Where a LHB has contractor lists with a relatively high weighting, the LHB normalising index will be greater than 1. This means that the weighted population is higher than the raw population count. Whereas for LHBs whose contractors have a low global sum weighting, the LHB normalising index will be less than 1. B9. In table A, the weighted population is determined by multiplying the raw population count by the LHB normalising index. The raw population is the sum of all the contractor lists in the LHB and that is shown at the bottom of column H. Annex B Global Sum MPIG Final

11 Table A: Practice list and age/sex breakdown (UNWEIGHTED) LHB raw LHB normalising index* Weighted population this quarter population in this Quarter ALL LHB ,407 11,750 A B C D E F G H MALES Age groups Total Contractor A , ,700 Contractor B , ,975 All Males LHB ,300 1, ,675 FEMALES Age groups Total Contractor A , ,000 Contractor B , ,075 All Females LHB ,325 1, ,075 TOTAL Age groups Total Contractor A ,025 1, ,700 Contractor B ,600 1, ,050 ALL LHB 475 1,175 4,625 2,950 1, ,750 * Provided by the Assembly, by dividing the registered population by the weighted population at a national level Annex B Global Sum MPIG Final

12 Table B - The raw data for each of the practices scaled by the weighting factor for the LHB B10. For the next stages in the calculation, the contractor lists adjusted by each index are normalised back to the weighted population calculated in Table A. This means that the contractor lists by age and sex are scaled so that the aggregate of the all the contractor lists in the LHB sums to the weighted population of the LHB. B11. In the example, all the age and sex categories for both of the contractors is increased by 23%. This process ensure that the weighting given to the contractors in each LHB is relative to all contractors in Wales, not just the contractors within the LHB. B12. Columns A to G of Table B identify the weighted age and sex breakdown of the two contractors. The raw list sizes have been weighted by taking the lists sizes under each age category from Table A and multiplying them by the LHB's normalising index of 1.23 *(LHB weighted population [14,407] divided by LHB raw population [11750]). B13. For example, in Table B the weighted list size for Contractor A in respect of males between 0 and 4 (column A) is derived from multiplying the number of males on Table A within that age band by the LHB's normalising index (100 x 1.23*) to give a weighted population of 123.* B14. This calculation is followed for each of the categories in turn. At the end it is totalled to give the weighted populations for both contractors within the LHB. Annex B Global Sum MPIG Final

13 TABLE B:Practice list and age/sex breakdown WEIGHTED) ALL LHB A B C D E F G H MALES Age groups Total Contractor A , ,310 Contractor B , ,648 All Males LHB ,820 1, ,958 FEMALES Age groups Total Contractor A , ,678 Contractor B , ,770 All Females LHB ,851 1,778 1, ,448 TOTAL Age groups Total Contractor A ,483 1,778 1, ,989 Contractor B ,188 1, ,418 ALL LHB 582 1,441 5,671 3,617 1, ,407 Annex B Global Sum MPIG Final

14 Table C - An adjustment for the age and sex structure of the contractor lists B15. The number of patients in each of the age and sex bands is then multiplied by the weighting for each of the bands. So, for example, a male in the 5-14 age band receives a weighting of 1, compared with a weighting of 6.72 for a female over 85 years. B16. The contractor lists are then summed. Each of the contractor lists are then normalised so that on aggregate they equal the LHB weighted population. The age/sex index for the contractor is its weighted list size divided by its unweighted list size. B17. Columns A to G of Table C show the age band weighting as determined by the global sum allocation formula. The weighted list sizes for each contractor by age and sex are multiplied by the age band weightings to produce an adjusted weighted population. That is then scaled back to the LHB weighted population in order to derive an age band index. B18. For example, in Table C: (i) (ii) the adjusted weighted population for contractor A in respect of females over 85 years is derived by multiplying the weighted population for this group in Table B by 6.72 (245 x 6.72) to give a figure of 1646 the same calculation is made for males in this age group (123 x 6.27 = 771) and this is added to the figure for females to give a contractor total of 2,417 (iii) the figures for all age groups are totalled to provide a contractor total of 20,314 (column H) (iv) (v) this is scaled down to derive contractor A s share of the total weighted population of the LHB of 7,530 (column I). the scaled down contractor population is then divided by its pre-indexed weighted population to give the age/sex index for contractor A of 1.08 (column J). Annex B Global Sum MPIG Final

15 TABLE C: Age/sex i d A B C D E F G H I J Age Total NormalisedAge/sex Male i d Female (Table B (Table B * Table C B * A) col (Table B C * col ET Contractor 1, ,003 4,861 4,802 2,561 2,417 20,314 7, AContractor 1, ,116 5,067 3,901 1,439 1,016 18,551 6, B Total LHB 2,211 1,470 9,119 9,928 8,703 4,001 3,433 38,864 14, Annex B Global Sum MPIG Final

16 Table D - A nursing and residential home index B19. Patients in a nursing or residential home receive a weighting of 1.43 compared with other patients that receive a weighting of 1. B20. In the table below, contractor A has 40 patients in a nursing and residential home (column B), so these are given a weight of 1.43 (column D). The remaining patients are unweighted. The weighted and unweighted patients are then added together to derive a weighted population for the practice. This is then normalised, and an index derived. B21. For example, in Table D: (i) contractor A has a weighted population (from Table B) of 6989 (column A) and 40 patients in a nursing or residential home (column B) (ii) this figure is multiplied by the common weighting of 1.43 to give an adjusted weighting of 57 (column D) (iii) the remaining patients of contractor A (column C) are then added to this adjusted number to derive a weighted patient number of 7006 (column E) (iv) this is scaled down to derive contractor A s share of the total weighted population of the LHB of 6,993 (column F) (v) the scaled down contractor population is then divided by its pre-indexed weighted population to give the nursing and residential home index for contractor A of (column G). Annex B Global Sum MPIG Final

17 TABLE D: Nursing and residential home i d A B C D E F G Practice Patients in residental or Weighted patients in res Total weighted Nurs & res population nursing home Other patients or nurs home patients Normalised index Weights col A - col B B4 * col B col C + col D col F/ col A Contractor A 6, , ,006 6, Contractor B 7, , ,426 7, Total LHB 14, , ,432 14, Annex B Global Sum MPIG Final

18 Table E - An adjustment for list turnover B22. Evidence has shown that in the first year of registration patients require 1.46 times more care than other patients. In the example below, therefore, the patients within their first year of registration receive a weighting of The remaining patients receive a weighting of 1. The weighted and unweighted patients are added together, and then the values are normalised to the LHB weighted population. B23. For example, in Table E: (i) contractor A has a weighted population of 6,989 (column A) and new patients totalling 350 (column B) (ii) the number of new patients is multiplied by the common factor of 1.46 to give an adjusted new patient number of 511 (column D) (iii) the remaining patients of contractor A (column C) are added to the adjusted number of new patients to give a revised weighted population for the contractor of 7150 (column E) (iv) this is scaled down to derive contractor A s share of the total weighted population of the LHB of 7,037 (column F) (v) the scaled down contractor population is then divided by its pre-indexed weighted population to give the list turnover index for Contractor A of (column G). Annex B Global Sum MPIG Final

19 TABLE E: List turnover i d A B C D E F G Patients within their Weighted Total List Practice fi year of Other registration i hpatient d Normalise Weight l i i i 1.46 i 1.00 d inde col A - col B4 * col col C + col col F / col Contractor 6, , ,15 7, AContractor B 97, , ,48 7, Total 14, , ,63 14, Annex B Global Sum MPIG Final

20 Table F - An adjustment for the additional needs of the patients on the contractor lists B24. The measure of standardised limited long standing illness and the standardised mortality ratio are used to weight the contractor population for additional need. These measures are derived for each contractor by linking the patients on the contractor list with the ward in which they live using their postcode. The average value for all the patients on the practice list determines the value for the contractor. These values are multiplied by weights that have been determined based on empirical evidence of the relationship between the measures and the utilisation of primary care services. B25. Again, the weighted populations are normalised and converted into an index for the contractor. For example, in Table F: (i) the adjustment for contractor A multiplies the weighted population in Column A (from Table B) by the total of the constant of (column B) and the result of multiplying the weights for long standing illness (column C) and mortality (column D) ratios by the relevant figures for each contractor (ii) these calculations provide the Contractor s Need weighted population figure of 341,200 (column E) (iii) (iv) this figure is scaled down to derive contractor A s share of the total weighted population of the LHB of 7,009 (column F) the scaled down contractor population is then divided by its pre-indexed weighted population to give the needs index for contractor A of (column G). Annex B Global Sum MPIG Final

21 TABLE F: Needs index A B C D E F G Standardised limited long Standardised Practice standing illness mortality ratio population Constant (SLLI) < 65 Coefficients Population weighted for need Normalised Needs index col A * (col B + C5 * col C + D5 * col D) col F / col A Contractor A 6, ,200 7, Contractor B 7, ,075 7, Total LHB 14, ,275 14, Annex B Global Sum MPIG Final

22 Table G - An adjustment for the unavoidable costs related to the location of the contractor B26. The adjustment in table G is to take account of geographical variations in staff costs. The market forces factor (MFF) is determine by estimating the unavoidable variation in employment costs in different parts of the country. The value given to each contractor reflects the MFF zone in which it sits which is mapped using the postcode of the surgery. On average, around 48% of the global sum is accounted for by staff costs, so this is the proportion of the contractor list weighted by the MFF factor. B27. For example, in Table G: (i) (ii) (iii) (iv) (v) the adjustment for contractor A takes its weighted population in column A from (Table B) and multiplies it by the contractor s MFF for staff of 1.3 (column B) to derive a population weighted for MFF of 9,086 (column C) this figure is then multiplied by 48% (the common staff costs percentage) to give the MFF weighted population for MFF patients of 4,361 (column D) the remaining population unadjusted for MFF of 3,634 (column E) is added to the adjusted population in column D to provide the overall MFF weighted population of 7,995 (column F) this figure is scaled down to derive contractor A s share of the total weighted population of the LHB of 7,305 (column G) the scaled down contractor population is then divided by its pre-indexed weighted population to give the MFF index for contractor A of (column H). Annex B Global Sum MPIG Final

23 TABLE G: Unavoidable cost A B C D E F G H Population Populatio weighted Registere population Practice Staff for MFF x 52 Tota Normalis Inde Weight col A * col B col G / col A Contractor 6, ,08 4,36 3,63 7,99 7, Contractor 7, ,16 3,91 3,85 7,77 7, Total 14,40 17,24 8,27 7,49 15,76 14,40 Annex B Global Sum MPIG Final

24 Table H - An adjustment for the unavoidable costs related to the rurality of the surgery B28. Evidence has shown that the rurality of a practice also affects the cost of delivering services. This is measured in two ways: (i) distance of patients from the practice surgery. The value for the practice is the average distance between the surgery and the patient s home for all the patients on the contractor s list; and (ii) by the average population density of the wards in which all the contractor s patients live. This is done by mapping patients to wards using the postcode of the patients on the list. B29. The rurality weighting is applied to 58% of the practice list, so the other 42% of the practice list is given a weighting of 1. For example, in Table H: (i) the adjustment for contractor A takes the difference between multiplying the weights for average distance (column B) and population density (column C) by the relevant figures for each contractor and multiplies the net figure by the weighted population in column A (from Table B) to arrive at the gross population for rurality of 414,304 (column D) (ii) (iii) (iv) (v) this figure is then multiplied by 58% (the common rurality weighting) to give the weighted population for rurality patients of 240,296 (column E) the remaining population unadjusted for rurality of 2,935 (column F) is added to the adjusted population in column E to provide the overall rurality weighted population of 243,331 (column G) this figure is scaled down to derive contractor A s share of the total weighted population of the LHB of 7,318 (column H) the scaled down contractor population is then divided by its pre-indexed weighted population to give the rurality index for contractor A of (column I). Annex B Global Sum MPIG Final

25 TABLE H: Unavoidable cost (rurality) i d A B C D E F G H I Population Population weighted Registered Log average Log pop weighted for for rurality x population x Practice distanc density rurality 58% 42% Total Normalise Rurality Coefficient col A * (col B * 0.05 col C * 006) col H / col A Contractor 6,989 1, ,30 240,29 2, ,23 7, Contractor 7,418 1, ,87 232,50 3, ,62 7, Total 14, ,17 472,80 6, ,85 14,407 Annex B Global Sum MPIG Final

26 Table I - Combining each of the indices the total weighting for each contractor B30. The next step is to combine all of the indices mentioned above into a single contractor weighting. Each index, listed below in columns B to G, are multiplied together to generate the contractor weighting for each practice. The contractor weighting is then multiplied by the raw practice population to produce the weighted population, in column I. Finally, the weighted population is normalised to produce the normalised weighted population in column J. B31. For example, in Table I: (i) (ii) the individual indices for contractor A in columns B to G are multiplied together to derive the contractor weighting of (column H) this is then multiplied by the contractor s weighted population in column A (from Table B) to produce the adjusted weighted population of 8,328 (column I) (iii) finally, this figure is scaled down to derive contractor A s share of the total weighted population of the LHB of 8,242 (column J). Annex B Global Sum MPIG Final

27 TABLE I: Total practice weighting (combined index) A B C E D F G H I J col B*C*D*E*F*G col A * Col H Practice population Age/sex index Nursing & Residential home index List turnover index Additional need index MFF index Rurality index Contractor weighting Weighted population Normalised Weighted Population Contractor A 6, ,328 8,242 Contractor B 7, ,229 6,165 LHB total 14,407 14,557 14,407 Annex B Global Sum MPIG Final

28 Table J - Calculating the initial Global Sum Monthly Payment and the correction factor B32. The next step is to calculate the initial global sum payment and the correction factor. Column D shows the global sum before any adjustments. This is calculated by multiplying the normalised weighted population (column C) by 50, taking 50 as an example level of funding per weighted patient. B33. Column E then shows a payment of 2.18 for each weighted patient in practices within London PCTs. A London PCT is defined as any PCT in any of the 5 London SHAs. In this example, just as an illustration, only one contractor in the PCT is located in London. Contractor B is within a London PCT and so each patient on the raw registered list (6,050, rather than the weighted population of 6165) attracts 2.18 generating around 12,000 for the contractor. I have reinstated this by rejecting the deletion rather than rewriting the whole thing.b29. Column F shows the historic opt-outs, taken from the global sum. If the contractor did not provide in the baseline period any services now defined as additional services then the value of the opt-outs in 2002/03 is included here. If the contractor stopped providing the service after the 2002/03 baseline period, the value is kept in the global sum. B34. In this example, Contractor A previously did not provide maternity services and contraceptive services in the baseline period. Contractor A has a historic opt-out equal to 4.5% of their Global Sum which is made up of a year of opt-outs for maternity services (2.1%) and contraceptive services (2.4%). Contractor B has no historic opt-outs. B35. Column G shows the total initial global sum, being the sum of columns D & E. Column H shows the Global Sum Equivalent for each contractor. Column I shows the difference between the Global Sum Equivalent, and the total initial global sum after the historic opt-outs are subtracted (see below for description of historic opt-outs). Column J shows the value of the Correction Factor for each contractor if the value of column I is greater than zero, the contractor will receive this value as a Correction Factor under the MPIG arrangements. B36. Column K shows the adjustment for temporary patients, to reflect a contractor s obligation to provide emergency treatment to people not registered with them, and to provide treatment to temporary residents. This is based on the average annual amount Annex B Global Sum MPIG Final

29 claimed for these items over the last five full years, and is explained in detail in the SFE and chapter 5 of the guidance. Column L shows the total global sum (before opt-outs) and correction factor payments for the practice. B37. Columns M and N simply show the Total Initial Global Sum and Correction Factor as monthly payments. Annex B Global Sum MPIG Final

30 TABLE J: Initial Global Sum monthly payment & Correction F t Funding per Funding per patient ( ) 2.18 A B C D E F G H I J K L M N Raw LHB List size Weighted List LHB List size Size Normalised Global sum weighted by to LHB PCT index weighted (Col C * 50 patient funding) A Historic opt outs Initial Global Sum (Global Sum GSE GSE-(initial global sum-historic opt ) (Col A * 2.18 patient funding) (Table L Col K) (Col D + E) (Col H - (G - )) MPIG: Correction factor* Temporary patients adjustment** Initial Global Sum and MPIG payment + Temp patients adjustment Total initial Global Sum monthly payment Correction factor monthly payment (Col G + Col J + ((Col G + Col (Col J if Col J > Col K) K)/12) (Col J/12) ) '000s '000s '000s '000s '000s '000s '000s '000s '000s '000s '000s Contractor A 5,700 6,989 8, Contractor B 6,050 7,418 6, ( ) PCT total 11,750 14,407 14, * The correction factor is calculated in the first quarter of It is then fixed for the rest of , but will be updated annually by a figure determined by the DH ** Emergency treatment, immediate necessary treatment and care of temporary residents. Based on rules set out in the SFE Annex B Global Sum MPIG Final

31 Table K - Adjusting the initial Global Sum monthly payments to take account of opt-outs B38. There are a range of services for which the practice can opt out of provision. The penalty for opt out is a percentage reduction in the global sum allocation, these percentages are described in chapter 2 of the guidance. The process for working out the reductions for opt outs is set out in table K. As the global sum is calculated quarterly, the calculation needs to adjust for the fact that opt outs may only apply for part of the quarter. For example, contractor B opted out of child health surveillance for one month of the quarter over which the payment is being calculated. Therefore the opt out penalty is scaled down to reflect the fact that for only 31 days of the 91day quarter the service was opted out of. B39. The following table then applies the opt out penalties to the practices total global sum payment (including the Temporary Patients Adjustment). Column A shows the global sum monthly payment and columns B to I calculate the percentage reduction in the global sum income from outing out of services. Column J is the summed total of percentage opt outs. Column K and L then work out the total monetary penalty for the opt out services, and reduces this amount from the global sum calculation. Column M then calculates the total global sum and MPIG entitlement, building on the GSE calculations in Table J. Annex B Global Sum MPIG Final

32 Annex B Global Sum MPIG Final v.31/01/04

33 TABLE K: Adjusted initial monthly payment Opt out of additional A B C services D E F G H I Childhood Maternity immunisation and Vaccinations Cervical Child Health Minor Medical Contraceptive pre-school and Out-of-hours Screening Serveillance surgery Services services boosters immunisations services % of Initial GSMP Contractor A* Contractor B* Funding implications of opt outs A B C D E F G H I J K L M Total initial Global Sum monthly payment Cervical Screening Child Health Serveillance Minor surgery Maternity Medical Services Contraceptive services Childhood immunisation and pre-school boosters Vaccinations and immunisations Out-of-hours services Total percentage opt out Total value of opt out Adjusted Global Sum Monthly Payment Total adjusted Global Sum and MPIG monthly payment (B5 * col B) (C5 * col C) (col B+C+D+E+F+G+H+I) (col A * col J) (col A - col K) (col L + Table J col N '000s '000s '000s '000s Contractor A Contractor B Total LHB * Based on proportion of quarter for which opt out will be in place e.g. 31 days out of 91 days = 31/91 = Annex B Global Sum MPIG Final

34 Table L - Defining the Historic opt-outs adjustment B40. The historic opt-outs are subtracted from the Initial Global Sum before the correction factor is calculated. It is based on the value of services that the practice opted-out of in the months covered by the Global Sum Equivalent. Since the funding for these services will not be in the GSE, it should also be subtracted from the global sum. B41. The historic opt-outs are calculated in a similar way to the future opt-outs. There is a fixed percentage reduction in the global sum for each of the additional services. In this case the Temporary Patients Adjustment is not added to the Global Sum to calculate the historic opt-out. Annex B Global Sum MPIG Final

35 TABLE L: Historic opt outs Opt out of additional services A B C D E F G H I Cervical Screening Child Health Serveillance Minor surgery Maternity Medical Services Contraceptive services Childhood immunisation and pre-school boosters Vaccinations and immunisations Out-of-hours services % of Initial GSMP Contractor A* Contractor B* Funding implications of opt outs A B C D E F G H I J K Initial Global Sum (Global Sum + London) Cervical Screening Child Health Serveillance Minor surgery Maternity Medical Services Contraceptive services Childhood immunisation and pre-school boosters Vaccinations and immunisations Out-of-hours services Total percentage opt out Total value of opt out (B5 * col B) (C5 * col C) (col B+C+D+E+F+G+H+I) (col A * col J) '000s '000s Contractor A Contractor B Total LHB Annex B Global Sum MPIG Final