GP funding system penalises practices in deprived areas, LMCs warn

GP practices in areas of high deprivation are being 'penalised' by current funding structures and need more money to tackle growing health inequalities, GPs have warned.

LMC conference sign

At the UK LMCs conference 2022 in York, delegates said that surgeries in deprived areas were under-resourced to deliver for patients, adding that they also found it harder to hit targets for additional funding.

GPs voted for the BMA’s GP committee to conduct a review into the impact of current national and local general practice funding models, including funding formulae and outcomes payments and asked for fairer funding of immunisations.

Frustration with the current general practice funding model comes after a GP policy expert told MPs earlier this year that the way GP services are financed at present perpetuates health inequality

GP funding

Kensington, Chelsea, and Westminster LMC GP Dr Lisa Harrod-Rothwell, who proposed the motion, said that the pandemic had ‘starkly exposed’ existing inequalities. But she warned the current funding formula ‘penalised and undermined’ practices looking to tackle these issues.

She said: ‘The Health Foundation found that practices in England serving the most deprived areas receive less funding due to the nature of the funding formula and nearly all other income streams. How can that possibly make sense? So underfunded practices are unable to reach incentive payment targets and so are penalised.

‘The funding of practices, and therefore the funding for their patients’ care, should not be lower because they serve a community with greater need. Practices should be empowered and enabled to critically prioritise and work innovatively with their local communities and advocates for our patients.’

However, a number of GPs spoke against the motion as they stressed the awarding of additional funding should not come down to ‘who thinks they are working hardest’. Dr Alastair Taylor from Glasgow LMC said: ‘We all know that deprivation increases workload, but there are many other ways that workload has increased.

Excess workload

‘I know we are all struggling with excess workload, especially thanks to the pandemic, and that we need more GPs, and more allied health professionals to support us and more funding. But for everyone, not just those working in areas of deprivation.

Responding to the motion, chair of BMA GPC UK Dr Phil White, said: ‘GPC UK is committed to doing all it can to tackle health inequalities, especially in the wake of COVID-19, which has widened the divide in many areas of the UK.

‘It can be incredibly difficult for GPs to see the impact these inequalities have on our patients, which is why we desperately need proper resources to combat them and ensure that everyone, regardless of where they live, has easy access to things like basic health education and local NHS care.’

He added: ‘GPC UK and its six component committees are already considering funding models in the context of a sustainable general practice future for the NHS, and will be reflecting on this motion and seeing how it could inform future policy.’

In evidence to the House of Commons health and social care committee in March, 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.

A Health Foundation report published in 2020 warned that GPs in England's most deprived areas care for 10% more patients with 7% less funding.

Motion in full:

That conference is deeply concerned by the rise in health inequalities in our communities and calls upon GPC to:

(i) conduct a review into the impact of current national and local general practice funding models, including funding formulae and outcomes payments

(ii) negotiate enhanced funding for GP practices serving areas of significant deprivation to resource addressing the additional workload

(iii) negotiate a requirement for a health impact analysis to be carried out by commissioners when any new housing or care homes are located in these areas of deprivation

(iv) negotiates for fairer funding of vaccinations which does not financially discriminate against practices with low vaccine uptake.

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