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ICB to continue Fuller-lauded funding model despite GP criticism

ICB to continue Fuller-lauded funding model despite GP criticism

A new GP funding model based on population need has been awarded money to run until next year, despite facing criticism from local GPs.

The pilot run by Leicester, Leicestershire and Rutland ICB – whereby the cost-of-staff element in the Carr-Hill formula calculation has been replaced with a needs-and-deprivation element – had been lauded in the Fuller stocktake.

The landmark review said that said that the pilot meant action was taken to address inequalities in the existing primary care funding model, ‘which is primarily driven by age and gender and not reflective of actual patient need at practice level’.  

But last year, Leicester, Leicestershire and Rutland LMCs told Pulse that a survey found opposition to the model, with some responders saying that the system was ‘very unclear’, ‘poorly handled’, ‘chaotic’ and ‘inadequate.’ 

Now, as reported by Pulse’s sister title Healthcare Leader, the model has been awarded funding until April 2025, and the ICB said it will be reviewing its running and the impact on patient experience and outcomes.

As part of the pilot, 127 practices across LLR were grouped into four categories from most to least underfunded, recognising that all practices in LLR feel underfunded.

The most underfunded half of practices were given a share of £2.85million from the ICB annually from April 2022, with £119,000 being the maximum amount a single practice received in 2024, to bring them up to the average level of funding for the patient needs at their practice.

The practices in the least underfunded half didn’t receive any extra money under the pilot.

Leicester, Leicestershire and Rutland LMCs chair Dr Grant Ingrams told Pulse that the pilot is ‘a plaster’ which is being used locally, and ‘it has its limits’.

The LLR GP funding formula uses patient-level data looking at the individual patients that make up a practice while also taking into account deprivation and communication issues, which is a particular challenge in Leicester City.

Dr Ingrams said: ‘First of all, this is a positive thing, although there are concerns about how stable it is and about how accurate it is.

‘But the fact that the ICB has decided to continue to invest quite a significant amount of money in this is positive.

‘The problem that we found wasn’t with the formula, it was with Covid, when the actual demand went up by over 20%.’

He added that if practices where funded ‘properly’ and there was a ‘proper national formula’ such scheme would ‘not be needed at all’.

He said: ‘This is trying to make up a deficit. It is helpful, it’s additional money which is there to make up for the problems with the national formula.

‘The ICB have done an awful lot of work, and we spent a lot of time with them to actually understand their rationale and how they have actually developed the formula and its robustness.

‘We feel that it is understandable, but it will never be right until they actually sort out the national funding formula – something needs to be done nationally to solve the problem with Carr-Hill. This is a plaster which is being used locally but it has its limits.’

Pulse has contacted LLR ICB for comment.

Last month, the RCGP called on the Government to ‘radically’ reform GP funding in England, highlighting that the current Carr-Hill formula disadvantages patients in poorer areas.

The LLR model as described in the Fuller stocktake

In Leicester, Leicestershire and Rutland action has been taken to address inequalities in the existing primary care funding model, which is primarily driven by age and gender and not reflective of actual patient need at practice level.

They are also tackling disparities in service provision; a population health-based model found that underfunded areas were the most deprived.

The new model calculates practice payments by setting aside the core staff components, based on the current practice core contract income.

The remainder of core contract funding and other funding in the model is distributed to practices based on needs and deprivation. As a result, approximately £3 million was identified to rebalance a fairer level of baseline funding across all practices, based on need and demographics, and the model enables future investments in primary care to be transparently distributed at practice and place, based on population health need.

Source: Next steps for integrating primary care, Fuller stocktake report