GP funding formula needs radical overhaul, report warns

General practice needs more investment and a radical overhaul of its funding formula - along with a 'black alert' system to flag dangerous workload, a report from NHS leaders has warned.

GP funding overhaul needed (Photo: Tim Grist Photography/Getty Images)
GP funding overhaul needed (Photo: Tim Grist Photography/Getty Images)

The NHS Confederation report calls for more investment in infrastructure to improve premises, management support and technology.

It calls for a 'clear set of measures that capture the pressure and workload being put on primary care', alongside honest communication with the public about what services can achieve - and a revamped funding formula that reflects variation in patient populations across the country and allows primary care to shape services accordingly.

The report comes as general practice faces intense workload pressure after more than a year of the COVID-19 pandemic. Recent figures from NHS Digital revealed that GP practices across England carried out nearly 3m more appointments in March compared with the previous month.

GP funding model

The Restoring Primary Care report stressed that a new funding model was needed to address ‘disproportionate investment’ in some areas and ‘fully embed a patient-centred approach’.

It said: ‘The current funding model via the Carr-Hill formula needs a radical overhaul. We know that increased investment in primary care is associated with lower healthcare costs and improved population health.

‘We need to invest more, incentivise outcomes not processes, and make them relevant to different populations. For example, let’s move away from targeting each of our diverse populations and expecting the same outcomes.’

Primary care leaders added that any replacement model needed to be honest about what work could be achieved by PCNs - and stressed that regulatory oversight should not ‘add to workload’.

Premises

The paper also highlighted that infrastructure ‘fit for the 21st century’ was required by practices after the pandemic to continue to deliver high-quality consultations. It said: ‘We are building new services based on our patients’ needs, but this requires us to expand our workforce and we have insufficient space within our premises.

‘We would like to innovate, particularly around looking after our under-served communities, but need more management support and joined-up IT systems with our health and care partners.’

The BMA warned in February that practices risked missing out on hundreds of millions of pounds in recruitment cash because practices had no room to accommodate staff employed via the additional roles reimbursement scheme (ARRS).

Primary care leaders added that an operational pressures escalation level (OPEL) for primary care, similar to the one used in hospitals, was required to ensure teams were working at safe levels. The BMA unveiled guidance in 2018 setting out how a GP black alert system could work - and at least one LMC has declared a regional black alert over unmanageable workload.

Demand for services

NHS Confederation director of primary care Ruth Rankine said: ‘Primary care is the front door of the NHS and carries out 90% of contact with patients, but the challenges it now faces cannot and should not be underestimated.

‘Rising demand, growing complexity, higher expectations, increased administrative burden and the continued challenge of rolling out the largest ever vaccination programme mean primary care is under immense pressure.

‘Primary care leaders are committed to working together and doing everything they possibly can for their patients, but an open and honest discussion needs to be had, coupled with a clear set of achievable priorities. Otherwise, there is the very real risk of care becoming disjointed and services being overwhelmed.’

Ms Rankine told GPonline last week that a clear plan was needed to help teams manage growing workload and protect staff against burnout and guarantee safe patient care.

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