Carr-Hill GP funding formula review announced as part of 10-year NHS plan
The upcoming 10-year plan for health will include a review of the Carr-Hill formula for GP funding, so that ‘working-class areas’ receive their ‘fair share of resources’, the Government has said.
Health secretary Wes Streeting will announce ‘major changes’ to how GP funding is distributed to ‘help working class communities and coastal areas’ during a speech on the 10-year plan in Blackpool today.
According to the Government, the review will look at how health needs are reflected in the distribution of funding through the GP contract, ‘drawing on evidence and advice from experts’ such as The Advisory Committee on Resource Allocation (ACRA), and ‘in consultation’ with the BMA GP committee.
Doctors leaders told Pulse that it is ‘essential’ that any changes to the Carr-Hill formula are accompanied by an overall increase in funding for general practice, as simply redistributing a fixed pot of funding risks creating new pressures in other areas.
NHS England has recently said that the plan, which is expected to be published at the beginning of next month, will be ‘GP-centric’ but will not come with huge investment in primary care straight away.
The Government said that the plan will ‘address the inequalities in GP services across England’ since GP surgeries which serve ‘working class areas’ receive on average ‘10% less funding per patient’ than practices in more affluent areas.
It pointed to RCGP data showing that practices in some of the country’s poorest areas have roughly 300 more patients per GP than the most affluent regions.
Mr Streeting will say: ‘Thanks to the reforms we’ve made to bear down on wasteful spending, we can now invest the savings in working class communities that need it most.
‘Where towns have the greatest health needs and the fewest GPs, we will prioritise investment to rebuild your NHS and rebuild the health of your community.’
The current formula is supposed to ensure resources are directed to practices based on an estimate of their patient workload, taking into account ‘drivers of workload’ and ‘unavoidable costs’.
But both the RCGP and the BMA have argued for years that it needs to be replaced to accurately reflect the communities that practices care for.
In 2015, Pulse revealed that NHS England and the BMA were discussing plans for practices with ‘atypical’ populations to be given their own contracts under plans being discussed by GPC and NHS England as part of the latest review.
But changes to the formula had been under consideration since 2007 – just three years after it was introduced, partly because of concerns that practices with atypical populations, or those in deprived areas, do not receive sufficient funding to support them to treat their patient demographics.
The Doctors’ Association GP spokesperson Dr Steve Taylor told Pulse that a review of the Carr-Hill formula is ‘long overdue’.
He said: ‘It’s important that areas of deprivation receive more funding, but the details will be important. New funding needs to be found for general practices but this can’t be at the expense of other areas.
‘Incentives to improve GP to patient ratios would be one thing that would help, deprived areas average one GP per 2,500 patients, but some practices have one GP per 5,000 and this needs to change.’
Professor Azeem Majeed, head of the Department of Primary Care and Public Health at Imperial College London, told Pulse that the current formula ‘has not kept pace’ with changing population needs and does not sufficiently account for levels of deprivation or the complexity of care required in more disadvantaged communities.
He said: ‘A properly weighted and adequately resourced funding model is essential if we are serious about tackling health inequalities and ensuring high-quality primary care for all. The announcement of a review of the Carr-Hill formula is therefore very welcome and long overdue.
‘We know that general practices in deprived areas face higher levels of multimorbidity, greater social complexity, and greater demand.
‘And yet NHS funding for primary care has not adequately reflected this. However, it is also essential that any changes to the Carr-Hill formula are accompanied by an overall increase in funding for NHS general practice in England.
‘Simply redistributing a fixed pot of funding risks creating new funding pressures in other areas and undermining services that are already stretched.
‘We need to increase the overall investment in general practice so that patients in deprived communities receive the care they need, without destabilising provision elsewhere.’
NHS England national director for primary care Dr Amanda Doyle said: ‘It is essential that GP practices serving our most deprived communities, where health challenges are often greatest, receive a fair share of resources that reflects their need.
‘The NHS is committed to ensuring people can access the help they need as quickly and easily as possible and ensuring funding reflects this will help us to do just that.’
Earlier this year, modelling by two ICBs found that implementing a new GP funding formula based on population need would cost just £333m in England.
