This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

GPs buried under trusts' workload dump

Carr-Hill formula 'very unlikely' to create more equitable allocation, finds study

The NHS payments formula to practices is 'very unlikely' to benefit practices in more deprived areas, a new study has found.

The Carr-Hill Formula, also known as the global sum allocation formula, was introduced in 2004 as the basis of core funding for GMS practices to ensure funding reflects factors that influence patient needs and costs. 

Researchers from the University of Leicester analysed data for 6,900 UK practices over 2013/17 - published by Public Health England, NHS England, NHS Digital, the GP Patient Survey and the Department of Health - to investigate whether payments made under the formula increased more in practices located in the most deprived practices.

The study, published in the British Journal of General Practice, found that for every 10% increase in the practice’s Index of Multiple Deprivation score, payments only increased by 0.06%, which suggests the current formula is very unlikely to lead to a more equitable allocation of NHS practice funding. 

The researchers said the study's outcomes 'raises the question of what the payment system is intended to achieve and what the NHS’s priorities are, given the persistent and wide disparities in health outcomes between the more and less privileged.'

They added: 'Not only does the existing NHS payment formula for general practices operate less than optimally to reflect practice population health needs, but it also has little redistributive potential and is unlikely to lead to any substantial narrowing of gaps in funding between practices with differing workloads due to the characteristics of their populations.

'The continuing absence of any measure of deprivation in the Carr-Hill formula means that some practices, particularly those working with socioeconomically disadvantaged populations, are not currently or imminently likely to receive the necessary additional funding they require to handle a greater workload.'

The research follows a previous study by the University of Manchester that found that the formula was 'inaccurate' and 'out of date'.

The Carr-Hill formula has been subject to an on-off review since 2007, after being frequently criticised for not sufficiently taking into account deprivation.

A House of Commons briefing paper published in September 2019 said that 'a new funding formula will be developed to better reflect practice workload, including deprivation and rurality' by April 2018 but no significant changes have been implemented yet.  

In 2017, NHS England released guidance saying CCGs should identify which practices were disadvantaged by the Carr-Hill allocation formula and offer them the required support.

Earlier this year, RCGP Scotland warned that funding for some practices in the most deprived areas will worsen health inequalities under the new GP contract.

Readers' comments (8)

  • Its taken nearly 15 years to figure this one out, brains of britain I think not.Meanwhile we are in an impending workforce implosion and where do you think it will collapse first.Deprived areas of course.Reap what you sow.

    Unsuitable or offensive? Report this comment

  • 3000 home visits at my practice last year. They were to old people, and very old people.
    ‘Deprivation’ comes in many forms including isolation loneliness frailty and dementia.

    Global sum funding is woefully short

    NHSE keep giving the money to charlatans like Babylon to pander to the snowflakes, and persecuting practices for the odd ‘ghost’ patient with a foreign name who hasn’t been for a couple of years.

    Let’s have some decent funds for the frail elderly housebound and care home patients

    Unsuitable or offensive? Report this comment

  • A formula that nobody knows how it works says it all. Smoke and mirrors to confuse the GPs.
    The only fair way is payment by the time spent and per consultation. No cheating by the government.

    Unsuitable or offensive? Report this comment

  • We have known this for years!!! As an inner city deprived area - our funding via MPIG losses have been going down

    We were promised a review of the formula and thisbhas never happened. We need a deprivation payment - for extra staff

    Unsuitable or offensive? Report this comment

  • I look up Boomla’s work on GP consulting by deprivation and the Swedish system of capitation by individual risk scores, which led to more GPs choosing to work in deprived areas.
    The data and tools are there for a better system; the political (including BMA) will is not.

    Unsuitable or offensive? Report this comment

  • We have known this right from the start, and yet nothing has been done. The Carr-Hill formula is still secret - so much for transparency! It completely fails to deliver what it sets out to do -- i.e. to create a fair reward system which supports those GPs working in more difficult conditions, or with more demanding or more complex patients.

    Unsuitable or offensive? Report this comment

  • If you have a skewed Carr Hill, it doesn't pay to join PCNs because you have to commit to do work for the full list but the peanuts which is the 14p is paid only for 70-75 percent of your patients. Additional services for the weighted out 25-30% is the Practices problem. I would say that those signing with lower weightage need to really think if they want that added 20-25% unpaid work - no OBEs here and the pennies not worth their metal cost.

    Unsuitable or offensive? Report this comment

  • think everyone should get the same. We all have different issues. My practice is "affluent" but is dispersed over miles and endless housebound, high demanding elderly.

    Unsuitable or offensive? Report this comment

Have your say