GP leaders call for 'comprehensive' Carr-Hill review specific to Wales

GP leaders in Wales have called for a ‘comprehensive’ review of the Carr-Hill funding formula specific to Welsh practices’ needs.

At their national conference in Newport, LMC leaders from across Wales also called on the Government to commission practices to provide GLP-1 therapies, and demanded a GP retention scheme to support GPs ‘at risk of early exit’.

They also said they believe formal negotiation and agreement of the GMS contract ‘should remain with the recognised tripartite parties’, in order to ‘avoid’ conflicts of interest and to ‘protect the integrity’ of the independent contractor model.

It comes after, at the end of last year, Welsh GP leaders reached a deal with the Government resulting in £41.9m of investment for 2025/26.

Addressing the conference, GPC Wales chair Dr Gareth Oelmann said: ‘In December last year, after months of robust negotiations, we reached a credible settlement for the 2025/26 GMS contract.

‘This is not just a contractual uplift; it is a signal that the Welsh Government has begun to grasp the severity of the situation and the value inherent in GMS.

‘For years, we said: “Invest in general practice, it benefits the entire NHS”; this year, that message landed. The recurrent nature of this investment means stability for practices, not short-term solutions.

‘This agreement is absolutely a step forward. But, let me be clear; we must continue this momentum onward to address and reverse what has been over a decade of underfunding.’

The LMCs said that they believe that the ‘continued use’ of the Carr-Hill formula to allocate GMS funding in Wales ‘no longer reflects the realities of modern general practice’, and risks undermining the financial and operational sustainability of practices.

The UK Government has asked the National Institute for Health and Care Research (NIHR) to produce an ‘overall recommendation’ on replacing the Carr-Hill formula, which could include a departure from the existing approach – but the Welsh LMCs said that there should be a comprehensive review tailored to Welsh practices.

On weight-loss drugs, the conference said that there is ‘growing evidence for the effectiveness of GLP-1 receptor agonists’ in weight management but that access being limited to private provision is ‘widening health inequalities’, and practices should be commissioned to provide and monitor GLP-1s with appropriately funded Supplementary Services.

The Welsh Government has already said it is developing a new model to expand capacity across specialist, primary care and community settings to make weight-loss drugs more widely available while providing wrap-around support.

Previously, the weight-loss medication was only available on the NHS in Wales through specialist weight management services.

It follows NICE’s approval of tirzepatide in December 2024 for treating obesity in adults, with an estimated 186,000 people in Wales potentially meeting the eligibility criteria.

The relevant motions in full

2 North Wales Conference calls for the introduction of a rolling three-year GMS settlement cycle (with appropriate safeguards such as inflation proofing) to include:

multi-year indicative funding envelopes
early identification of new service developments with additional resourcing
sufficient lead-time for practices to plan, deliver, and evidence activity. TAKEN AS REFERENCE

3 Gwent This Conference notes that GMS contract negotiations in Wales are conducted on a tripartite basis through established negotiating bodies. Conference believes that formal negotiation and agreement of the GMS contract should remain with the recognised tripartite parties, while allowing appropriate engagement with other stakeholders to inform the process, in order to avoid conflicts of interest and to protect the integrity of the independent contractor model. PASSED

25 Bro Taf This conference calls on Welsh Government to look at ways to retain experienced GPs. Retention is cheaper than training and recruitment and more cost effective than reactive interventions. Workforce planning must prioritise retaining senior GPs alongside training new GPs.
Conference calls on Welsh Government to:
i. expand and properly fund the retainer scheme to include specific support for GPs at risk of early exit PASSED
ii. lobby UK Government to resolve pension taxation disincentives that accelerate reduction in working capacity or early retirement PASSED
iii. introduce a national retention premium to support ongoing contribution of experienced GPs, prioritising practices in areas of high need or at risk of closure LOST

27 North Wales The underemployment crisis, which is affecting newly qualified GPs disproportionately, has continued unchecked over the last year. Conference calls on GPC Wales to work with Welsh Government to provide sufficient additional funding to GP practices to enable employment of the large numbers of newly qualified GPs who are currently struggling to find sufficient work and are instead looking at other options overseas or in different careers. NOT REACHED

39 Bro Taf That this conference believes that the continued use of the Carr Hill formula to allocate GMS funding in Wales no longer reflects the realities of modern general practice, and risks undermining the financial and operational sustainability of practices. This conference therefore calls on GPC Wales to:

work with Welsh Government to commission a comprehensive review of the Carr Hill formula and its relevance to current Welsh practice needs PASSED
ensure that any revised funding mechanism takes full account of factors such as deprivation, rurality, multimorbidity, and population ageing REFERENCE
advocate for transitional support arrangements to protect practice viability during any period of funding reform PASSED
publish an assessment of how the present allocation model impacts equity, workload, and sustainability across Welsh practices. REFERENCE

56 Gwent* This Conference notes the growing evidence for the effectiveness of GLP-1 receptor agonists in weight management and the widening health inequalities created by access being limited to private provision. Conference calls on Welsh Government to commission GMS to provide and monitor GLP-1 therapies with appropriately funded Supplementary Services. PASSED

Source: BMA