Exclusive: GP funding shift to London as formula change hits north of England

London's share of core medical primary care funding is set to rise by almost 6% over the next five years, while other parts of England will see their share fall by nearly 4%.

GPonline analysis of NHS England funding allocations data shows the extent of shifts in the share of total funding between areas.

The capital is set to gain with its share of total GP funding rising from 15.8% in 2015/16 to 16.7% in 2020/21, a 5.8% growth in its share. Meanwhile the Cumbria and North East subregion will see its share fall by 3.8% from 6% to 5.8%.

Cumbria LMC secretary Dr Peter Higgins said general practice in all parts of the country needed a greater share of NHS funding at a time when more services were being shifted out of hospitals.

The region, he added, had two broken and overspending health economies. ‘In those environments primary care provides more services than it would in central London,’ he said. ‘It’s not so easy for people to pop to A&E or an outpatient appointment. And general practice is a much richer environment, but there are more pressures on practices to deal with things that would otherwise go to hospitals. So the formula should be going the other way.’

GP funding

The changing share of total GP funding each commissioning area receives is designed by NHS England to take account of projected population growth and historic under or over spending. Finance officials at the commissioning body divide up the core general practice budget, excluding centrally administered project funds, to take account of population growth and to move each area as quickly as possible without destabilising it towards a target allocation calculated by a formula.

Documents published by NHS England at the end of 2015, which revealed the national allocation for general practice, explained the allocation formula had been amended using updated workload data.

The new allocations formula revealed an increase in the relative need for primary care in London, and also reduced the range of the most extreme relative needs, flattening the overall distribution. Part of the effect of the updated formula on the distribution of new funding, on top of the effect of expected population growth, can be seen in each region’s share of total funding over the period.

While some areas, such as the South West, Cumbria and North East, and the North Midlands are set to see their share of overall funding fall by over 3% over the period, all areas will see funding rise.

Share of GP funding

When it announced the national allocation in December NHS England said general practice would see funding rise between 4% and 5% a year, or 25% over the period.

The new data show that with centrally administered money such as the £250m a year infrastructure/transformation fund stripped out, core general practice funding is set to rise 16.8% nationally from 2015/16 to 2020/21.

London will gain most with a 22.7% funding increase over the period, while the South West, Cumbria and North East and the North Midlands will see funding increases below 14%.

GP funding increases

The data for per capita funding allocations, which is the focus of the allocations targeting work, shows Cumbria and the North East has the highest per capita funding at the beginning and at the end of the period, increasing from £136 in 2016/17 to £148 in 2020/21, an 8.8% growth. At the bottom the South Central subregion starts at £121 increasing almost 10% to £133. Nationally funding per capita will rise from £127 to £140.

GP funding per capita

Annually, Cumbria and the North East will see funding increase under 2% in some years. Dr Higgins said that was ‘derisory’. Most of this year’s 3-4% increase would go on superannuation rises, he said. The promised increases would mean ‘probably going backwards for practices’, he added.

Changes to the funding allocation formula which determines target allocations have not been replicated in the Carr-Hill formula, which delivers funding at practice contract level, although the allocation formula is based on Carr-Hill. The practice-level formula is itself currently under review by NHS England, which is considering whether changes should be made to better reflect the increased workload caused by deprivation.

GP contract

Changes to commissioning areas’ allocation indicated in this data will not directly affect practice funding which is set separately by GP contracts. GP leaders, however, believe changes to the allocation formula could point to future plans for changes to the contract formula.

Core general practice funding is also just one element of the income practices receive, with CCG contracts becoming an increasingly important element of many practices’ income. 

GPC deputy chairman Dr Richard Vautrey said that no part of the UK had sufficient funding to deliver a safe and sustainable service and practices in all areas are struggling as a result. 

‘To shift resources from one underfunded area in England to another is simply to rob Peter to pay Paul, and will make matters worse not better. We need significant funding investment into general practice, not more tinkering at the edges, with a commitment from all NHS England regions to deliver at least 11% of NHS funding to general practice, and start my committing 11% of the £3.8bn spending review allocation to general practice.  This would at least show that they were committed to properly solving this crisis.’

An NHS England spokeswoman said: 'GPs are at the forefront of NHS services and so we have increased funding for their services despite the challenging financial climate. GP funding is designed to be as consistent as possible across the country, ensuring fair and equal access for all patients.'

*Click on the charts to explore the data

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