Average funding per weighted patient across England has been rising steadily as contract deals over recent years have increased practice income. GPonline has mapped the latest official data to show how funding varies regionally - and assessed some of the factors that may be maintaining these differences.
The gap between CCG areas where practices receive the highest level of funding per weighted patient and the areas where funding is lowest has remained relatively steady - with a gap of around £100 between the best and worst funded in the three most recent financial years for which data are available.
In 2017/18, the most recent year for which data are available, practices in West Norfolk CCG received on average £223 per weighted patient - more than any other area. Practices in Manchester CCG, where funding per weighted patient was the lowest in England, received just £122.
Across England as a whole, average GP practice funding per weighted patient has risen steadily from £136.01 in 2013/14 to £152.05 in 2017/18. But the gap between CCGs with the highest average funding per weighted patient and the lowest has remained almost unchanged.
The gap between top and bottom in 2017/18 was £101 - identical to 2015/16, when the highest funding per weighted patient was £210 and the lowest £110, and 2016/17 when the range was from £217 to £116.
So what are the factors that maintain this gap between the highest and lowest funding per weighted patient between CCG areas?
Two key factors are numbers of dispensing practices and the prevalence of PMS contracts, which in some areas have been used to pay practices for services over and above the standard GMS offer.
Although these factors may not be the sole causes of variations in practice funding, they are significant. In the 10 CCG areas with the highest average funding per weighted patient, all have either a large proportion of PMS practices, dispensing practices, or both.
Average funding per weighted patient for dispensing practices in England is £193 - compared with £144 among non-dispensing practices. Among GMS practices average funding per weighted patient is £149, compared with £156 for PMS practices.
Taking a specific example, in North Norfolk CCG where practices received on average £221 per weighted patient in 2017/18, all 19 practices listed are dispensing.
This level of average funding per weighted patient is the second highest for any CCG area in England. To demonstrate the extent to which this above-average funding is driven by dispensing income, once dispensing fees are stripped out and drug reimbursement fees are adjusted to the national average among non-dispensing practices, average funding per practice in the CCG drops to £141.
This is fairly close to the national average figure of £152.05, and even closer to the adjusted £145 national average for practices that emerges once dispensers and 'atypical' practices - those for which a full year of data is not available, or where large swings in patient numbers have distorted the figures - are excluded from the data.
Specialist practices can also have significant effects on CCG average payments. In Oxfordshire CCG, for example, a homeless practice that receives well over 10 times the national average payment per weighted patient singlehandedly drives up the CCG-wide figure by £4. This effect occurs despite the fact that the CCG is relatively large, with 75 practices in total.
Once that practice, along with those for which full figures are not available, and the one in three practices that are dispensers are stripped out, Oxfordshire's average payment per patient drops from around £167 to around £149.
GPC chair Dr Richard Vautrey points out that figures for some APMS GP practices paid to provide 8am-8pm cover, which may have unusally low registered patient populations, can also skew CCG averages.
He said: 'There is a variation in funding levels across the country and this is often due to the different level of services commissioned by CCGs from local practices, as well as the necessary funding required for practices providing the additional service of dispensing. Some CCGs, and PCTs before them, have had a long history of trying to invest into general practice, while others have all too often failed to do so.'
But the Leeds GP warned that even with recent investment promised as part of the NHS long-term plan and the five-year contract agreed for general practice, GPs in all areas need more funding to cope with rising pressure.
'Wherever a practice finds itself, there is still a gap between workload and the necessary funding to be able to respond properly to patients' needs,' he said. 'Even with the additional investment committed through the recent contract deal, there remains an urgent need for CCGs to step up their local investment.'