Publication, Part of Proposed Dispensing Feescales for GMS contractors in England and Wales
Proposed Dispensing Feescales for GMS Contractors, England and Wales - 2023, October release
Calculation of New Feescales
The calculation follows a six-step approach set out in the methodology agreed by the negotiating parties (see Annexes A and B). In August 2023, a slight modification to the methodology was agreed to address the continuing fluctuation between overspend and underspend year on year. This revision to the methodology uses more suitable multipliers to calculate the adjusted and anticipated spend for the first and second half of the year. This method uses the price for the average number of fees per practice to calculate the April and October adjustment factors that are applied at Step 2 of the methodology and the step that calculates the April fee scales. Also, to calculate the anticipated spend for October to March of the year, it uses the change in the volume of fees for that six-month period rather than the annual change in volume of fees.
This methodology has been implemented for calculating the 2023/24 feescales.
All data used are for England, but it is anticipated that the new feescales will also be accepted for use in Wales.
The formula used to calculate the new feescales for the second half of 2023/24 is:
new fee = current fee x (E - W) / Z
where
E = envelope for 2023/24
W = adjusted spend for first six months of 2022/23
Z = anticipated spend for second six months of 2023/24 based on current feescales
This calculation is detailed in the 'Calculating the October Feescales' section below and the associated Feecsales for October can be found in the October Feescales section.
A similar calculation is carried out to establish what the feescales would have been if implemented from 1 April 2023 for the whole of the financial year.
The formula used was:
new fee = current October fee x (E / X)
where
E = envelope for 2023/24
X = anticipated full year spend for 2023/24 based on current feescales.
This calculation is detailed in the 'Calculating the April Feescales' section below and the associated Feecsales for April can be found in the April Feescales section.
Please note, calculations are performed on unrounded data but figures are rounded for presentational purposes.
Calculating The October Feescales
Step 1
Calculate the envelope [E] for 2023/24 in line with negotiated agreement
For 2012/13 it was agreed that the envelope should be re-based to a starting figure of £170.00m.
Since 2012/13 this new methodology has been used to calculate the envelope. Future envelopes will be split (60:40) into two elements, cost and profit, and each element will be separately uplifted:
- The cost element (60%) will be uplifted each year using a two-year average of the volume increase/decrease of fees
(for 2023/24 = 2.1%)
- The profit element (40%) will continue to be uplifted by the agreed net pay uplift [1]
(for 2023/24 = 4.24%)
Calculating the envelope:
Variance between 2022/23 Envelope and 2022/23 Outturn
= 2022/23 Envelope - 2022/23 Actual outturn
= £188.51m - £212.34m
= -£23.83m (overspend)
Adjustment to be made in 2023/24 for 2022/23 overspend
= Variance x 60%
= -£23.83m x 0.6
= -£14.30m
Adjusted 2022/23 Outturn
= 2022/23 Outturn + Adjustment for 2022/23 overspend
= £212.34m + -£14.3m
= £198.04m
Cost Element of 2023/24 Envelope
= (Adjusted 2022/23 Outturn x Cost Element Percentage) x Average Annual Volume Change
= (£198.040 x 0.6) x 1.0209
= £121.31m
Profit Element of 2023/24 Envelope
= (Adjusted 2022/23 Outturn x Profit Element Percentage) x DDRB Uplift
= (£198.040 x 0.4) x (1.0424) [1]
= £82.57m
Envelope for Year 2023/24
= Cost Element for 2023/24 + Profit Element for 2023/24 + Adjustment for 2022/23 overspend
= £121.31m + £82.57m + -£14.30m
= £189.586m
E = £189.59 million
[1]Until 2019, this was either the figure recommended by the Review Body on Doctors' and Dentists' Remuneration (DDRB), or the figure implemented in England if the recommended figures was not used.
In 2019, a five-year GP contract was agreed in England with fixed practice contract funding and the GPC England and NHS England and NHS Improvement agreed that DDRB will not make recommendations on the uplift figure for GP partner net income for the duration of the deal, but that the agreed uplift figure of 2.0% would be used in 2019's calculation of the dispensing envelope.
In 2020, GPC in England, NHS England and NHS Improvement agreed that an uplift figure of 1.8% should be used; in 2021 and 2022, this figure is 2.1% and in 2023 an uplift figure of 4.24% was agreed.
Step 2
Calculate adjusted spend for the first six months (April - September) of 2023/24 [W] based on current feescale
Actual spend for the first six months 2022/23 = £82.02million
Adjustment for the change in the price for the average number of fees per practice from April 2022 to April 2023 = 1.1034 [2]
Adjust for the forecast volume increase for 2023/24 = 2.1 per cent (i.e. Average annual volume change in fees, see Annex A for details)
Therefore
Anticipated spend for the first six months of 2023/24
= Actual spend for first six months of 2022/23 x Adjustment factor for 2023/24
= £82.024m x 1.1034
= £90.50m
=Adjusted actual spend for first six months of 2022/23 x average annual volume change in fees
= £90.50m x 1.0209
= £92.40m
W = £92.40 million
[2] In August 2023 it was agreed that rather than using the adjustment factor that was calculated for the previous year's October feescales, the adjustment factor would be calculated based on the difference between the previous 2 year's price per prescription for the average number of fees (per practice) from the same 6 month period (ie April fee scales). The average number of fees per practice between April and September over the past 3 years = 1,270. The price used to calculate this adjustment factor was the price per prescription for this prescription band.
Step 3
Calculate anticipated spend for the second six months (October - March) of 2023/24 [Z] based on current feescale
Actual spend for the second six months 2022/23 = £130.31 million
Adjust for forecast volume increase for 2023/24 = 3.15 per cent (i.e. Average October to March increase in volume of fees, see Average October to March Volume Change for details) [3]
Therefore
Anticipated spend for the second six months of 2023/24
= Actual spend for second six months of 2022/23 x Average percentage October to March change in fees
= £130.31m x 1.0315
= £134.425m
Z = £134.42 million
[3] Previously the annual increase in prescription fees was used to forecast the anticipated number of prescription fees between October and March, however, the revised methodology introduced in August 2023 uses the average change in fees for the same six month period.
Step 4
Calculate the adjustment factor for October feescales
Given that:
E = £189.59 million
W = £92.40 million
Z = £134.42 million
Then (E – W) / Z =
(£189.59 - £92.40 ) / £134.42 = 0.723 i.e. the ‘adjustment factor for October feescales’
The “prices per prescription in pence” for each feescale, taken from the most recent proposed feescales, are then multiplied by the ‘adjustment factor’ [new fee = current fee x (E-W)/Z]. The resulting figures are shown in the “Proposed New Feescales” section of this paper, in the right-hand column of the Tables 1 and 2 entitled “Prices per prescription in pence”.
Step 5
Fees are paid on a sliding scale according to the numbers of items dispensed which are placed into bands each year. Changes in the numbers of items dispensed may cause practitioners to move bands which are therefore adjusted to take account of volume changes, i.e. each band’s width is increased/decreased by the two-year average volume change.
The average annual volume change in fees = 1.0209 per cent
The top and the bottom of each of the bands in both of the feescales were changed by this average annual change in volume.
The resulting figures are shown in Tables 1 and 2 in the Proposed New Feescales section in the left-hand columns of the tables entitled “Total prescriptions calculated separately for each individual dispensing practitioner, in bands”.
Calculating The April Feescales
Step 6
Calculate anticipated spend for April to September for 2023/24 [V] based on current feescale
From August 2023, an additional step was added to the methodology to calculate the anticipated spend for April to September (V). This step calculates a multiplier based on the price per prescription for the average number of prescription fees per practice from the feescales implemented the previous year. This multiplier is then applied to the total spend from April to September of the previous year to calculate an adjusted spend. The anticipated spend for April to September for the current year is then calculated by multiplying the adjusted spend for April to September from the previous year by the average annual change in volume of fees.
Multiplier to calculate anticipated spend for April to September 2023/24 = Price per prescription from the average number of fees pay band of the October 2022 feescale / Price per prescription from the average number of fees pay band of the feescale implemented April 2023
Given that:
Price per prescription from the average number of fees pay band of the October 2022 feescale = 266.425 pence
Price per prescription from the average number of fees pay band of the feescale implemented April 2023 = 230.085 pence
= 266.425 pence / 230.085 pence
= 1.1579
Multiplier to calculate anticipated spend for April to September 2023/24 = 1.1579
Adjusted Spend April to September 2022/23 = Total spend April to September 2022/23 x Multiplier to calculate anticipated spend for April to September 2023/24
Given that:
Total spend April to September 2022/23 = £82.02m
Multiplier to calculate anticipated spend for April to September 2023/24 = 1.1579
= £82.02m x 1.1579
= £94.98m
Adjusted Spend April to September 2022/23 = £94.98 million
V = Adjusted Spend April to September 2022/23 x the average annual volume change in fees
Given that:
Adjusted Spend April to September 2022/23 = £94.98m
average annual volume change in fees = 1.0209 per cent
= £94.98m x 1.0209
= £96.97m
V = £96.97 million
Calculating the April Adjustment Factor
Calculate anticipated full year spend for 2023/24 [X] based on current feescale
X = V + Z
Given that:
V = £96.97 million
Z = £134.42 million
= £96.97m + £134.42m
= £231.39m
X = £231.39 million
The April Adjustment factor = 0.819 which is applied to each pence value at each banding to get new value in proposed feescale.
This is calculated by using the formula E / X
E = £189.59m
X = £231.39m
Then E / X = 0.819 i.e. the ‘adjustment factor for April feescales’
Last edited: 26 September 2023 11:13 am