Communities across the country – including those in more deprived areas and coastal towns – are expected to benefit from a fairer distribution of GP funding as the government launches a review to tackle healthcare inequalities across the NHS today (Thursday 9 October).
The current formula for distributing GP funding – known as the Carr-Hill formula – is based on data that is around 25 years old in some cases. The formula uses expected workload of GP practices to determine distribution of funding for GP practices across England.
People in more deprived areas and coastal towns often have the highest needs for the NHS, but the fewest GPs, the worst performing services, and the longest waits.
Data shows that on average the GP practices that close for good are in areas with areas of higher deprivation. The impact is inequality of access, with the GP patient survey showing that people living in the most deprived areas of the country find it the hardest their GP over the phone, website or app – nearly two-thirds of people in the most deprived areas reported a good experience when contacting their GP, compared with nearly three-quarters of those living in the least deprived.
For example, in London, there are 2,501 patients per GP compared to the South West, where there are 1,967 patients per GP – meaning there are over 500 more patients per GP in the country’s capital – with the poorest areas of the city facing the widest disparities. This worsens health inequalities with more people in these areas spending more of their lives in ill health and with a lower life expectancy as a result.
Analysis by the Nuffield Trust shows that practices in poorer areas employ fewer GPs, with a worse average patient experience, and poorer Care Quality Commission Ratings.
Evidence from the Health Foundation also suggests that GP practices which serve more deprived areas of the country are receiving nearly 10% less funding per patient than practices in more affluent areas.
For example, Leicester, Leicestershire and Rutland Integrated Care Board calculated their funding requirements based on the needs of the local population – as opposed to workload – and found there was a vast disparity in the distribution in funding with one in five practices receiving 10% too little or too much funding, and one in 15 practices facing an even bigger gap of 15%. The practices that had a shortfall were in the most deprived areas. Shortfalls in funding can lead to reduced services and inequality of access to primary care services. The Integrated Care Board supported those areas with a shortfall by providing additional funding.
The Chief Medical Officer’s 2021 Annual Report on coastal communities noted that in Morecambe, over the last 20 years, it has been challenging to recruit and retain General Practitioners and experienced practice nurses to tackle the significant health challenges and concluded that changes to the funding formulas could support deprived coastal areas, like Morecambe, with longstanding workforce recruitment difficulties.
The government has put General Practice at the heart of the 10 Year Health Plan, as part of the major shift from hospital to community.
To deliver this shift the government has invested an additional £1.1 billion in General Practice; funded two above-inflation pay increases; recruited over 2,000 more GPs; and made online booking available to patients across the country.
Ahead of his attendance at the Royal College of General Practitioners Conference in Newport today, Minister of State for Care Stephen Kinnock said:
“The way GP funding is allocated is outdated and no longer fit-for-purpose – with more deprived areas and coastal communities across the country experiencing the highest levels of inequality.
“With GPs at the heart of our 10 Year Health Plan, it is vital that we don’t leave any community behind and that we end the postcode lottery of care.
“As we invest in primary care – we must prioritise the areas and communities which have the most need to drive health improvements and close the gap on these health disparities.”
Minister Kinnock is speaking at the Royal College of General Practitioners Conference in Newport today (Thursday 9 October).
Dr Amanda Doyle, NHS England national director for primary care said:
“It is essential that GP practices serving our most deprived communities, where health challenges are often greatest, receive a fair share of resources that reflects their need.
“By overhauling GP funding for the first time in two decades, the NHS can better help people to get the support they need as GPs and their teams deliver record numbers of appointments for their communities.”
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said:
“A review of the funding formula for general practice is long overdue and something the College has called for, alongside an uplift in funding for general practice overall.
“A patient’s postcode and where they live should not determine the level of NHS care they receive. It can’t be right that people in deprived communities – who often have more complex health needs and would therefore potentially benefit from health interventions most – are less likely to receive it, because GPs in deprived areas are responsible for hundreds more patients per head on average than those practising in more affluent areas.
“We look forward to feeding into this review and working alongside the Government to ensure that a new funding model works for practices, recognises and addresses health inequalities, and ensures that funding is directed towards the areas of greatest need.”
Dr Duncan Gooch, GP and chair of the NHS Confederation’s Primary Care Network, said:
“We welcome the government’s announcement to start the review of the Carr-Hill formula. It’s an important opportunity to ensure that funding for general practice truly reflects the needs of today’s patients and communities. The formula must take proper account of factors such as deprivation, population growth, and the rising complexity of health needs — as well as the increasing workload facing practices.
“If we want to tackle health inequalities and strengthen primary care at the heart of a neighbourhood health service, this review needs to deliver a fairer, more future-focused funding model.”
Jacob Lant, CEO of National Voices said:
“Reviewing the Carr-Hill formula was one of our core asks of the 10-year plan, as it’s fundamental to the Government realising its commitment to reduce health inequalities. It has long been hard to square that the most deprived communities receive the least GP funding and changing this formula is an important step to ensuring better and fairer access, a founding principle of the NHS.”
The six-month review will launch today (Thursday 9 October) and will be conducted by the National Institute of Health and Care Research (NIHR).
The review will identify a new allocation formula; assess the impact and feasibility of implementing it while ensuring it aligns to the government’s 10 Year Health Plan; and make an overall recommendation to replace the outdated Carr-Hill formula.
GP practices in England are now required to keep online consultation tools open from 8am to 6:30pm, Monday to Friday – freeing up phone lines and helping to end the 8am scramble.
The move will tackle health inequalities by supporting patients – no matter where they are – in being seen and treated quicker.
