1. The impact of the NHSScotland Resource Allocation Formula (NRAC) on remote and rural areas of Scotland The report of the Technical Group on Resource Allocation (TAGRA)

2. Overview Background on TAGRA Background on NRAC NRAC’s report TAGRA’s report

3. Background to TAGRA Formed after NRAC report Maintains and develops formula Brings together Government, NHS Boards, and academics

4. NRAC formula Assesses relative need for healthcare NOT absolute need Needs consistent and comparable national data

5. Background to NRAC Ran from 2005-2007 Recommendations accepted by Cabinet Secretary as improvement over Arbuthnott formula First used to inform allocations in 2009/10

6. NRAC recommendations Changes to all elements of the formula Unavoidable excess costs: –Increase for remote and rural community services –Decrease for remote and rural hospital services

7. Unavoidable excess costs Previous adjustment based on road km NRAC’s concerns: –Disadvantage boards with mixed geographies –Did not help planning within boards –Did not adjust for differences due to MLC –Unstable and gave counter-intuitive results

8. TAGRA’s review Two parts: –Analytical element –Consultation with NHS Boards

9. Analysis (1) unavoidable excess costs Based on adapted SG urban-rural classification New adjustment: –More stable over time –Robust to shocks –Uses appropriate care programme weights

10. Analysis (2) GP out of hours Raised by Audit Scotland and Parliament TAGRA concluded: –Cost data unavailable at time of NRAC –No existing evidence how need varies with age-sex and MLC –Area of formula that could be improved

11. Consultation with boards Interview with 6 boards Key cost pressures identified: –Service design restrictions –Staff restrictions –Dispensing GP practices –Agenda for Change

12. Consultation with boards TAGRA’s conclusions: –Issues raised relevant to all boards –No evidence of differential impacts –Open to reconsidering in light of new evidence

13. Conclusions of report Generally, current adjustment fair, appropriate and robust Improvement over Arbuthnott Potential to review GP out of hours now that new data is becoming available