It is likely that there will be separate contracts for practices with ‘atypical populations’ or those in deprived areas, as it has been agreed that the Carr-Hill formula is unable to devise a formula that is fair to all.

The Carr-Hill formula, which is currently used to determine the basic global sum received by practices based on the demographics of their patients, is under review, and there are concerns that these atypical practices do not receive sufficient funding to support them.

A spokesman for the General Practitioners’ Committee (GPC), which has been in talks with NHS England over the matter, said that the contract, which could be national or local, could be one option to solve problems exposed by the withdrawal of the minimum practice income guarantee (MPIG) and Personal Medical Services (PMS) premiums.

He added that it is “simply not possible” to have a single national contract that can do justice to the specific needs of practices that have certain atypical populations and said that in some cases it may be possible to look at a contract designed for the needs of certain categories of practices, while in others, the atypical nature may be very specific to the practice, so would need a particular arrangement.

The atypical populations that have been suggested include practices with young populations, those caring for the homeless, drug users and nursing home patients and those with large numbers of temporary residents.

However, the new contracts may not apply to all of these groups and NHS England will report to the Carr-Hill Formula review steering group regarding which populations could be included in the review and which would require an alternative solution.

Commenting on the proposal, a spokesperson for NHS England said that it will continue to work with the GPC on the review with the aim of adapting the formula to better reflect workload and deprivation.