Leading MPs have urged NHS England to review PCN funding mechanisms to ensure they do not worsen health inequalities.
In its new report into the future of general practice, the House of Commons health and social care committee warned that significant pressures facing under-doctored, highly deprived areas are compounded by ‘unfair funding mechanisms’ that fail to account for deprivation.
The Committee found it ‘particularly concerning’ that funding provided via the PCN contract ‘repeat this failing and risk entrenching regional variation’.
It called on NHS England to review new PCN funding mechanisms to ensure they do not ‘inadvertently restrict funding for areas which already have high levels of need’.
MPs flagged that the Additional Roles Reimbursement Scheme (ARRS) does not account for deprivation, meaning that places which already struggle to recruit staff may find it more difficult.
They also highlighted that the Investment and Impact Fund (IIF) is weighted according to prevalence and list sizes but does not account for other factors, such as lower vaccine uptake among patients from some ethnic minority groups compared to white patients.
This might mean areas with a larger population of Black and ethnic minority patients will need to work harder than other areas to achieve high coverage.
During the inquiry, MPs also heard that continuity of care is more difficult to achieve in very deprived areas, often due to existing GP shortages and patient populations with complex health needs.
Dr Sarit Ghosh, clinical director for Enfield Unity PCN, said: ‘Neither the core weighted patient list nor the PCN adjusted formulae take deprivation into account in a significant way and this has the potential to widen the gap in wellbeing and life expectancy. Recruitment, retention and achievement of population health outcomes are much more difficult in deprived areas and funding consequently should be higher.
‘My PCN bridges both affluence and deprivation and although the former has its own challenges – achieving good diabetic control in the latter population has historically been more difficult.’
Kieran Gilmartin, clinical director for Fareham and Portchester PCN, said: ‘The reason ARRS funding is a problem is that very few places can use 100% of it. There often aren’t enough people out there, and certain roles are going to add more value than others – certainly in the patients’ eyes.’
He added: ‘If you’re already in an area of staffing deprivation, it’s not just about patient deprivation. Most don’t want to work in an area that’s failing because you would be putting yourself under a high level of pressure.’
Dr Jeremy Carter, clinical director for Herne Bay PCN, said that other system decisions that risk exacerbating inequality include ‘redistributing unspent ARRS funding’ – funding that often goes unspent due to factors aligned with deprivation.
He said: ‘Funnelling that funding away is simply going to exacerbate the problems for struggling PCNs.’
During the inquiry, Matthew Taylor, chief executive of the NHS Confederation, told the Committee there has been insufficient investment in management training.
He said: ‘We have created primary care networks; I do not think we have invested in the right way in terms of management capacity, organisational development and the space for primary care networks to innovate, but I still think it is the right idea.’
In today’s report, MPs also urged NHS England to introduce a ‘national measure of continuity of care’ to be reported quarterly by all GP practices by 2024.
