It has always struck me as odd that GP practices in deprived areas weren’t necessarily funded more than practices in more affluent areas. Under the current Carr-Hill funding formula for GP practices in England, the age of your patient population is the most significant factor in determining a practice’s funding.
Ever since the funding formula was introduced in 2004, the debate has raged whether this should be the case, and there have been a number of attempts to change this. Finally, it looks like we might actually see some change.
Dr Nikki Kanani, the NHS England director of primary care, last week called for the formula to change so practices in deprived areas more funding. They are struggling to recruit far more than those in affluent areas with a higher percentage of older patients, she said, and it is increasing health inequalities.
Last year, LMCs voted for a change in Carr-Hill to prioritise deprivation. With both NHS England and the profession seemingly in agreement, this should see a change in the 2024/25 contract (the next major negotiation).
Except, of course, it’s not that simple. The reason it has never changed is that it will create losers, as well as winners. For members of the BMA GP Committee, it’s been impossible to get a consensus because either they individually or their constituents would lose funding. And all practices – even those in less deprived areas – are struggling in some way.
There is, of course, a ready-made solution. When the 2004 contract was introduced, there were funding winners and losers then as well. But those who lost out were given a funding boost in the form of the minimum practice income guarantee (MPIG). It was imperfect, but it ensured deprived practices – among others – could actually survive. But this was phased out and, since then, a number of practices have closed, citing the withdrawal of MPIG.
We should be adapting the funding formula to benefit deprived practices. But, alongside this, we need a new MPIG to support practices who will lose out. It will mean more funding, but that’s better than practices closing, or vulnerable populations missing out on care. This idea might just fly.