Practice funding ‘very clearly needs reworking’, says RCGP

The Carr-Hill funding formula for practices in England ‘needs reworking very clearly’, the outgoing RCGP chair has said.

Professor Martin Marshall made the comments about the Carr-Hill formula today during think tank Policy Exchange’s event on the ‘future of general practice’.

NHS England’s head of primary care has also called for a ‘shift’ in GP funding allocations to support deprived practices.

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, and Professor Marshall’s comments today will put more pressure on negotiators to revise practice funding.

When asked whether the Carr-Hill formula should be reformed, Professor Marshall told delegates that it ‘needs reworking very clearly’.

He said: ‘When the Carr-Hill formula was designed however many years ago, it was largely based on workload, not on need. We need to be distributing resources on need. Now it’s really difficult to do that at a time when resources are really sparse. 

‘It’s very difficult to redistribute resources, but as and when new resources come in, they need to be differentially given to those communities that have greatest need for them and that’s fundamentally important.’

Professor Marshall added: ‘In the meantime, while the core distribution issue is being addressed – and I can’t remember how long it took for Carr-Hill to be designed but it was many years because it’s a really complex process – we need to be using more ad hoc sources of funding and that is happening at a local level.

‘A lot of practices are getting discretionary funding from previously their CCG [and] now from other parts of the health service in order to do things like employ nurses to go into schools to address the mental health problem with kids.’

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 month, NHS England’s head of primary care Dr Nikki Kanani said we need a ‘shift in our contractual framework and our funding allocation formula’ to put more emphasis on deprivation.

The RCGP also recently demanded extra funding for practices serving the most deprived populations to recruit and retain staff in under-doctored areas, as part of a comprehensive review of the Carr-Hill formula.

And 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.

The RCGP announced earlier this month that Professor Kamila Hawthorne has been voted its next chair and will take on the role for three years from November 2022 when current chair Professor Marshall departs.