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.