GP funding formula perpetuates inequality, MPs told

The formula used to deliver the bulk of funding to general practice in England perpetuates health inequality, a GP policy expert has told MPs.

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Health committee hearing (Photo: Francisco Cabeza Lopez/Getty Images)

In evidence to the House of Commons health and social care committee this week, GP and senior policy fellow at the Health Foundation think tank Dr Becks Fisher warned that the GP funding formula was the 'root cause' of underfunding for general practice in deprived areas.

Health Foundation research published in 2020 warned that GPs in England's most deprived areas care for 10% more patients with 7% less funding - and Dr Fisher told the committee that the failure of the GP funding formula to factor in deprivation was the key factor driving this imbalance.

Underfunding of general practice in deprived areas had been a factor for a 'long, long time', Dr Fisher told MPs - but she said that deprivation payments for practices from the 1990s through to the introduction of the new GMS contract in 2004 had gone a 'significant way towards improving it'.

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Map: Where are England's most underdoctored areas?
> GPs in England's most underdoctored areas caring for twice as many patients

However, the funding mechanism behind the 2004 GMS contract - the global sum or Carr-Hill formula, which remains the basis for allocating the bulk of funding to general practice - ignored deprivation.

'When this global sum formula was bought in 2004, it was in theory meant to account for the different needs experienced by different patient populations, but it didn't actually include any adjustment for deprivation,' Dr Fisher said. 'So for example, if you go to a 10% increase in deprivation, according to the Carr-Hill formula, you get 0.06% extra funding - that was research from colleagues at the University of Leicester.'

Dr Fisher warned that 'across almost all other income streams into general practice, for example, QOF or locally enhanced services, practices in more deprived areas get less money.'. She said: 'Wherever you look, the way that the payments work skews towards practices in more affluent areas getting more money, and that's how you end up with the 7% discrepancy.'

The Oxford GP told MPs that because the Carr-Hill formula weights heavily towards the age of patients and 'doesn't include any funding for deprivation', health inequalities 'play into the underfunding' of deprived areas.

GP funding

She said: 'Inevitably part of this is that we have such a large and increasing life expectancy gap. In areas of high deprivation our patients simply don't get to be "old, old" and so fewer of our patients will attract the extra funding that comes with the bigger adjustment for age.'

Asked by committee chair Jeremy Hunt whether that meant health inequalities were 'the cause of the underfunding of less affluent areas', Dr Fisher said: 'I would contend that the root cause and probably the place to look where we talk about challenging this would be the funding formula for general practice, but certainly health inequalities do themselves play into the underfunding.'

Office for National Statistics data for 2017-2019 show that men in England's least deprived areas can expect to live for 10 years longer on average than those in the most deprived areas - while the gap is eight years for women. The gap in healthy life expectancy is almost two decades.

GPonline reported earlier this year that GPs in some of England's most underdoctored areas are responsible for nearly twice as many patients as their counterparts in areas that have been more able to recruit.

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