Funding gaps affecting deprived GP practices ‘hardly narrowed’ since 2019, say researchers

The funding gaps between GP practices in deprived and affluent areas have ‘hardly narrowed’ since before the Covid pandemic and inequalities persist, with ‘no sign of future improvement’, researchers have found.

The study published in the British Journal of General Practice (BJGP) analysed trends in practices’ payments between 2019 and 2024 and their association with deprivation, after adjusting for geographical, population and organisational factors.

It recommended that in addition to the review of the Carr-Hill formula currently being carried out, the Government should consider ‘other payment streams’.

It comes after the Government asked the National Institute for Health and Care Research (NIHR) to produce an ‘overall recommendation’ on replacing the formula, which could include a departure from the existing approach. Pulse understands that the review has now concluded and is with the Department of Health and Social Care for consideration.

The researchers publishing in BJGP found that overall practice payments were 9–12% below inflation, adding that this was in effect, ‘a systemic funding cut’.

Although funding trends were ‘slightly better’ as deprivation increased, the actual amounts involved were ‘very small and thus of little help’, and these gains flattened for the most deprived practices, and for practices in urban areas or with higher numbers of chronically ill people, the researchers said.

Practices with already higher payments in the past gained more funding than those with historically lower payments, they added.

The study said: ‘Statistically, higher deprivation (IMD) scores had a curvilinear association with payment trends between 2018–2019 and 2023–2024; the positive association lessened as deprivation increased.

‘This finding was robust across sensitivity checks; however, during the study period real-terms payments decreased substantially after inflation adjustment (–12.6% retail prices and –9.0% health inflation).

‘Additionally, the model found: statistically significant geographical disparities independent of deprivation scores, with less positive trends in urban practices and in the London region; more positive payment trends in practices with higher baseline payments; and less positive payment trends in practices with a younger age structure.’

In order to address this, the study recommended:

• Ensuring payment uplifts match inflation;
• ‘Thoroughly reviewing’ the Carr-Hill formula to ‘better align with direct deprivation measures and reduce potential overcompensation’;
• And examining other payment streams for extending weighting and for switching performance targets to more work-sensitive metrics, where appropriate.

‘These actions may help the 10 Year Health Plan for England to achieve its pledge to close health inequalities,’ the researchers said.

Another recent study found that the workload element of the Carr-Hill formula should be replaced with ‘updated weights reflecting morbidity and deprivation’, adjusted for practice capacity and unmet need.

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’.