Pulse editor Jaimie Kaffash reflects on the RCGP’s calls to radically reform GP funding in England
In the years 1998-2000, we were worried about planes falling out of the sky due to the Millennium Bug, email was just becoming normalised, Man City were still a laughing stock and – it makes me feel very old to say this – some of the Pulse team, and presumably some of your trainees, weren’t even born.
The data that is used to calculate the funding received by practices in England is also from 1998-2000. The Carr-Hill formula – which uses this data – was introduced in 2004 (three years before the first iPhone was released).
Professor Roy Carr-Hill measured workload by analysing consultations lengths in what was a ‘flawed proxy for need’, as the Health Foundation puts it. Any GP knows that consultation length is based on availability, not need.
Yet it is still being used. And, as the RCGP, the NHS Confederation, the Health Foundation, and patient charity National Voices put it, it needs to be radically reformed.
Practices in deprived areas – and of course their patients – are the ones that suffer the most from the Carr-Hill formula. Take a look at any metric and you will see the more deprived areas have the fewest GPs per head of population, less funding per patient when weighted for need and higher numbers of practice closures. This of course does nothing to help narrow health inequalities. So even if Carr-Hill was appropriate at one point, it certainly isn’t now.
As I have argued many a time before, there is always a reluctance to change the Carr-Hill formula because there necessarily will be losers as well as winners. And even if there is more funding to support the funding losers (as if!), this will also cause problems – look at the fate of MPIG.
However, as it is being used now, it isn’t even ideological differences around whether patient age or deprivation is the most important factor when determining patient funding – it is that the data being used is out of date. The formula needs updating on this basis alone.
But while we are at it, the structure of the formula needs changing, and deprivation does need to be a greater factor. Because as it currently stands, health inequalities are growing and the way practices are funded contributes to this. It shouldn’t be an overnight change, because that would simply have the effect of more practices closing.
The Carr-Hill formula is getting on in years, and changing it should be a priority.
Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at editor@pulsetoday.co.uk
Resource allocation has always been a political and ethical minefield. It raises philosophical questions about equality, distributive justice and social engineering. Utilitarianism vs the Capability approach, empiricist vs rationalist. On the back of the Black report, I was excited when Carr-Hill’s formula was introduced and the intention was admirable but it hasn’t delivered. I’ve worked a lot in deprived areas (and a little in practices with the wealthiest patients) and, despite some genuinely great GPs working in poor areas, they don’t attract enough GPs nor the ancillary staff. Also many expensive PPP/Lift buildings built in deprived areas in my city to house GPs who were supposed to throng to them, but they’re half empty. No easy answers.
No formula could compensate for deliberate defunding and maladministrtation aimed at damaging primary care.
The idea of a funding formula was radical, it always needed updating based on experience of its effects.
At this stage it needs to be taken as one aspect of the overhaul of funding needed to resuscitate General Practice.
The entire country needs updating. Many so called developing country have much better infrastructure than we do. Immigrants come here, laugh at our state of affairs and go back to their countries feeling very grateful for what they have. How on earth did it get to this?