GP funding formula 'needs reworking' to target inequalities, warns RCGP

The formula used to distribute core funding to general practice 'very clearly needs reworking' to help tackle health inequalities, the RCGP chair has said.

Professor Martin Marshall
RCGP chair Professor Martin Marshall (Photo: Pete Hill)

Speaking at an event last week on the future of general practice, hosted by the Policy Exchange think tank, RCGP chair Professor Martin Marshall said that growing numbers of GP practices were starting to measure and understand the causes of inequalities in their local communities.

But he warned that despite progress through some local initiatives, 'a lot of the solutions' lie with policymakers and will depend on an overhaul of how NHS funding is distributed.

Asked if the Carr-Hill formula that underpins distribution of global sum payments to GP practices needed reform, he said: 'Yes, it needs reworking, very clearly. When the Carr-Hill formula was designed, however many years ago it was, it was largely based on workload, not on need. You need to be distributing resources based on need.'

GP funding

Redistributing resources at a time when they are 'sparse' is extremely difficult, the RCGP chair acknowledged.

However, he warned that 'as and when new resources come in they need to be differentially given to those communities that have greatest need for them - and that's fundamentally important'.

The remarks from the RCGP chair come just months after a GP policy expert told the House of Commons health and social care select committee that the current GP funding formula perpetuates inequality.

GP and policy expert Dr Becks Fisher told MPs in March that the failure of the GP funding formula to factor in deprivation was the key factor driving an imbalance in funding estimated to have left GPs in England's most deprived areas caring for 10% more patients with 7% less funding

Carr-Hill formula

The Carr-Hill formula weights practice funding based on factors seen as key drivers of workload including the age and sex of patients, additional needs of patients linked to illness and mortality and list turnover. It also factors in unavoidable costs linked to regional variation in pay for staff and the impact of rurality.

The formula has been under review for some time, but Professor Marshall acknowledged it could take years to bring in an alternative because of the complexity of the task.

In the meantime, general practices needed to use 'more ad hoc sources of funding' made available through local commissioners to set up specific services that target inequalities.

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