Experts back 'more sophisticated' GP funding model as major GMS reforms loom

The NHS should adopt a 'more sophisticated' GP funding formula based on more than twice as many factors as the current system, researchers have said.

GP funding (Photo: JH Lancy)
GP funding (Photo: JH Lancy)

The proposals for a major overhaul of the way GP funding is allocated could be factored into what negotiators say could be significant changes for general practice to be outlined in the coming months.

University of Cambridge researchers assessed the impact of 10 'patient and practice characteristics' on consultation rates. Looking at data on more than 300,000 patients registered with 316 GP practices in England between 2013 and 2014 they found 'robust trends in patient-level and practice-level factors associated with workload' that applied across consultations by GPs, nurses and 'all' practitioners.

The current model used by NHS England to allocate resources to CCGs relies on just four variables - sex and age group, rurality, deprivation, and number of new registrations - the researchers explain in a study published in the British Journal of General Practice

GP funding formula

But six further factors - ethnicity, smoking status, number of full-time equivalent GPs, number of full-time equivalent nurses, QOF score, and practice training status - are also closely linked to workload and consultation rates, the study found.

Expanding the factors used in funding allocation to these 10 areas would create a model that is 'of greater utility than that currently used by NHS England because it will inform the development of more sophisticated staffing models and resource allocation formulae, than analyses that have only considered a limited number of explanatory variables and/or practice-level variables', the researchers argue.

They add: 'These findings can also be used to help identify practices in particular areas that may need to be targeted for additional support, including infrastructure such as consultation space, because of their predicted higher workload.

Workforce planning

'For example, the findings show that practices in areas that have more older patients living in deprived areas (as in some seaside towns), or a higher proportion of patients from Asian ethnic groups, are likely to experience high workload, and this should be accounted for in workforce planning.'

The research into improved resource allocation systems for general practice come as NHS and GP leaders consider potential major reforms for the profession - including to the funding formula.

NHS England and the BMA confirmed in 2016 that they were beginning detailed talks on a new funding formula - and said at the time changes would not take effect before April 2018 'to protect practices from financial instability'.

This deadline has slipped, but GPC executive committee member Dr Krishna Kasaraneni wrote in a blog for GPonline earlier this year that the 'next few months are likely to bring significant changes' in 'five fundamental areas of general practice' including the funding formula review, a QOF review, the move to a state-backed GP indemnity system, premises and the partnership model - which is also the subject of a government review.

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