NHS England’s head of primary care has said we need a ‘shift in our contractual framework and our funding allocation formula’ to put more emphasis on deprivation.
Dr Nikki Kanani, speaking at the NHS Confederation Expo conference in Liverpool, gave the clearest hint yet that funding for practices in deprived areas will receive a greater share of funding.
She added that any shift in resources would lead to ‘winners and losers’, but said that we need to ensure the ‘most deprived communities get the time to have the care that they deserve’.
Dr Kanani said that the next contract, which will be negotiated with the BMA, gives an ‘opportunity’ to think how to bring about ‘equitable general practice’.
Since the introduction of the Carr Hill formula – which allocates funding for practices – in 2004, there has been huge debate around the emphasis it places on the age of the patient population rather than the practice’s deprivation levels.
Dr Kanani said: ‘We still have fewer members of primary care working in more deprived communities, which means that more deprived communities often get poorer care, because they can’t access people, which also means that those practices get less money.
‘Because actually at the heart of it, we need a shift in our contractual framework and our funding allocation formula. These are the things we can start to do as we move through the pandemic so that we can put ourselves on a better footing and make sure that we shift resources… that means there’s winners and losers.’
Dr Kanani said this will be addressed in discussions for the next contract in 2024/25.
She said: ‘We’ve got a new contract coming in 2024/25. We’ve got an opportunity now, to start thinking about what was really valuable about the first contract, what do we want to bed in, if it is about health inequalities, if it is about equitable primary care, that’s something we need to work on.’
One part of the discussions will be about ‘the funding allocation policy’, she said. ‘We’re going to have to have a serious think about, is the funding allocation formula right? If it isn’t, how do we start to have conversations that give us a formula that allocates based on the things that really matter?’
The primary care medical director said ‘we need to be funded and supported to do what our most deprived, most vulnerable community needs’.
She added: ‘That’s going to be difficult because… there’s going to be winners and losers, but we have a moral obligation to do that. And that’s what I want to focus on as we go into the next round of contractual conversations.’
In the same session, Dr Kanani said that talk around moving to a fully salaried service has led to lower GP morale.
The Carr-Hill formula has been subject to an on-off review since 2007, after being frequently criticised for not sufficiently taking into account deprivation, and there have been a number of attempts over the years to review the formula, none of which have led to any change.
Last year, the UK LMCs conference voted to overhaul the GP funding formula on the basis that it fails to account for the extra pressures placed on practices in the most deprived parts of the country.
A 2019 study of UK practices found that for every 10% increase in a practice’s Index of Multiple Deprivation score, payments only increased by 0.06%, adding this suggests this formula is very unlikely to lead to a more equitable allocation of NHS practice funding.
READERS' COMMENTS [15]
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every practice is deprived of funding
No argument with that but it should be increased funding all over as less deprived areas patients are very aware of the services and therefore use them more so just as busy if not busier.
Welcome this in principle, but as the total NHS ‘pie’ is too small, this is just rearranging the deckchairs on the Titanic …
This is definitely a move in the right direction. I work in a deprived area where our patients get iller and require more services at a younger age and die at a younger age than those in the leafy suburbs . We need the extra funding that is allocated by age at present 10-20 years sooner to enable us to provide the services needed when they are needed.
And there it is. “There will be winners and losers” One word defines this:- “losers” . Redistributing inadequate funds. All. Over. Again.
Prior to 2013, the MPIG (Minimum Practice Income Guarantee) kept deprived Practices afloat. Hardship kicked in as soon as NHS England removed MPIG funding, Promised to be recouped via global sum, it never was. Richer areas got more. NHS England then promised (so report me to GMC) to implement a revised Carr-Hill formula by 2017. All forgotten for a few crumbs, eh.
Well said, Nick.
1 – Nick Mann had it correct. Often the government has some ideal based idea which they push through and totally ignore any advice or reasoning that does not fit with their idea.
MPIG and removal of PMS contracts was one of the most obvious – those were not in place for no reason.
Removal of seniority payments has left people scratching their heads about a way to keep people working for the NHS in to the later part of their careers and keep people working as GP partners.
And finally almost everyone working in primate care has said smaller practices where everyone actually knows every patient, results in more personalised care, fewer healthcare costs and better healthcare – yet the government pushes ahead with impersonal PCN or super-practice agendas.
Perhaps listen to people who know the patients best and you might make improvements.
In Sweden primary care capitation is based on the complexity of the patient, for example ACG risk of hospital admission over next year. This rewards practices that cater for them on a more granular level than just their postcode, and resolves the currently punitive for practices who are sought out by those with health needs vs practices that discourage those patients from registering or staying with them.
Google Boomla’s work on primary care usage and deprivation – significantly higher in ages 40-80 for deprived population.
The Swedish System and the Dutch System are similar.
The Dutch System looks at both deprived postcodes getting more funding due to higher levels of physical and mental co-morbidities, to allow for more chronic disease work etc. and ALSO looks at the age of the patients. Older patients rich or poor ALL need more care and input. It cannot be one or the other. It has to be both. Affluent areas tend to have older patients which would allow for some compensation when redistributing funds.
Gilbert/Cornish are on the money with comments made and models used by our European and Scandinavian colleagues
Remains to be seen if HMG are going to address the true determinants of health outcomes which remain fiscal education opportunity in place to find a decent job and get reasonable housing Repairing fractured community cohesion and finally enabling wrap around care in the local community for older and frailer patients
The govt clearly are bent on an american model. another 67million patients is a 20% increase in business for US insurers so we are not such small fry as you may think. European models do not shove health money into the pockets of the rich and produce much better outcomes. We are just pawns and about to be sacrificed as far as I can see. Brexit being part of the process.
All GP funding should be given to Americans. No, don’t say that.
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