The Department of Health, Social Services and Public Safety (An Roinn Sláinte, Seirbhísí Sóisialta agus Sábháilteacha Poiblí) in Northern Ireland has recently made available on its web site the following report (plus annexes)
Allocating Prescribing Resources to Health & Social Services Boards: Introduction of a Weighted Capitation Formula
I attach below an excerpt from the background for more information. The full report is available at
LSE Health and Social Care
1.1 Expenditure on GP prescribing covers the costs incurred by General Practitioners in prescribing drugs to their patients. In 2001/02 this public
expenditure programme accounted for 16% (£274m) of the total Health and Social Services budget.
1.2 The distribution of the GP prescribing budget was based entirely on historic spend until the introduction of a weighted capitation formula in
1998/99. The capitation concept was first introduced by using a combination of the resource allocation formula in operation in Scotland at that time and historic spend. However, this was considered to be only an interim arrangement, the long-term aim being a Northern Ireland-specific
capitation formula. Since 1998/99 research has continued to develop a Northern-Ireland specific formula. In the interim, a partial Northern
Ireland-specific formula was introduced for the 1999/2000 allocations with movement to a full Northern Ireland formula for the 2000/01 allocations.
The formula has been gradually phased in and currently applies to some 62.5% of the total GP prescribing spend. The other 37.5% continues to
be driven by historic spend.
The Capitation Formula Approach
2.1 This report describes the approach and methodology of the capitation based formula for the allocation of primary care resources for prescribing to the four Health and Social Services Boards in Northern Ireland. The principle of weighted capitation means that resources are shared out across the four HSS Boards depending on:
The relative size of the relevant population;
The relative cost of each relevant age/gender group; and
The relative level of additional need (for example, higher levels of illness are associated with higher levels of deprivation even within the
same age/gender grouping).
These three main components of the capitation approach will be described in detail below but first it is worth noting some general principles
about the weighted capitation-based methodology.
2.2 Whilst the weighted capitation formula is based on an analysis of need at small area (practice) level, the Department only uses it to allocate
resources to Boards. It is Boards who then have responsibility for allocating resources to GPs within their area and use the formula to inform this allocation but can also draw on local knowledge.
2.3 It is also worth noting that the formula is not concerned with the absolute level of need for prescribing resources in Northern Ireland, but rather the relative level across Northern Ireland. The formula is about equitably sharing out across the four Boards, the "pot" of money already allotted to the GP Prescribing Budget for Northern Ireland, rather than varying its size or proposing any ideal level of overall NI prescribing budget.
2.4 In the absence of a pure measure of need for prescribing resources, a utilisation-based measure is used as a proxy. The weighted capitation
approach is evidence-based, taking account of the existing use of prescribing resources together with key factors such as population, age, gender and additional health and social care needs associated with deprivation, which determine the resources needed to fund GP prescribing
in each HSS Board. The overall aim of the formula is to ensure equal resource for equal need.