Carr-Hill GP formula should be updated to reflect morbidity and deprivation, say researchers

The workload element of the Carr-Hill formula for GP funding should be replaced with ‘updated weights reflecting morbidity and deprivation’, adjusted for practice capacity and unmet need, a new study has argued.

The study published in the British Journal of General Practice called for an 11.6% uplift in general practice workload payments to a minimum benchmark of £102.46 per weighted patient, which would result in payments per patient of £99.75 in the lowest deprivation decile, and £108.18 in the highest.

It comes as the 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.

The research pointed out that the Carr-Hill formula has not been updated for over 20 years and is based on ‘crude workload weights’ from 240 general practices. By contrast, other NHS funding formulae, such as the one used for local commissioners, had been more recently updated to include factors such as morbidity indicators.

The authors applied ‘a richer set of patient characteristics’ to the suggested payments for general practices in the analysis, including age and gender, new registration, ethnicity, deprivation, and morbidity, measured using 20 conditions recorded in primary care records.

The rise recommended would equate to an extra £677.77m in annual funding per year for general practice, estimated the research, which looked at payment information for 2023/24 across 6,213 practices with more than 1,000 registered patients.

Although such an increase would be ‘fiscally challenging’, it would ensure ‘equitable health care’ in general practice, the study argued. If that was not possible, smaller increases of £391.82m (£6.23 per patient) and £184.73m (£2.94 per patient) could boost equality in care.

The researchers suggested further adjustments for inequalities could be developed separately in line with other NHS formulae. In the longer term, they suggested routinely updated person-level primary care records should be used to inform payments, alongside practice and area characteristics.

They concluded: ‘The current formula is outdated, and updated needs-based workload weights should be used to inform payments to general practices. Additional concerns related to equity in outcomes and underfunding of practices in deprived areas should be addressed separately.

‘They could be addressed through specific adjustments, by revising other elements of the funding formula, or by considering redistributions of payments in schemes that directly target the challenges faced by those practices.’

The BMA has previously said that it has been told the current Carr-Hill review may need to be ‘cost neutral’, prompting warnings to avoid destabilising practices from whom funding may be removed.

The Treasury recently launched a review focusing on how to shift funding from hospitals into primary and community care, including testing new financial flows.

And an analysis conducted as part of the 10-year health plan recommended that the Government should consider different ways of funding general practice – including partial payment for a GP practice only being ‘released’ if ‘a certain proportion of patients confirmed they were satisfied with the waiting time before their appointment’.