10-year health plan to include review of GP funding distribution  

The government has pledged to review how GP funding is distributed so that ‘working-class areas’ receive their ‘fair share of resources’.

In a speech this morning in Blackpool, health secretary Wes Streeting said the upcoming 10-year plan for the NHS would include a review to the Carr-Hill formula for GP funding in a move to ‘help working class communities and coastal areas’.

But the Royal College of Nursing (RCN) stressed that the NHS plan must not just focus on GPs, but on the need to invest in ‘all areas of the community nursing workforce’.

According to the government, the review of GP funding will look at how health needs are reflected in the distribution of funding through the GP contract, ‘drawing on evidence and advice from experts’ such as The Advisory Committee on Resource Allocation (ACRA), and ‘in consultation’ with the BMA GP committee.

NHS England has recently said that the plan, which is expected to be published at the beginning of next month, will be ‘GP-centric’ but will not come with huge investment in primary care straight away.

RCN general secretary and chief executive, Professor Nicola Ranger, said patients in deprived, rural and coastal areas have ‘for too long’ struggled to access appropriate healthcare services.

Related Article: Supporting student nurses on placement in general practice

But she warned that long waiting times for care and poor health are not only driven by limited GP access.

‘For this to be truly successful, the new NHS plan must include significant investment across all areas of the community nursing workforce – including prevention and public health nursing services – which have seen numbers decline and funding reduced, particularly in the most deprived areas,’ she said.

Professor Ranger added: ‘Nursing staff stand ready to make this plan work, but they need to see a commitment to rebuild the whole workforce and not by making savings and moving funds around to boost care in selective areas.’

The government said that the plan will ‘address the inequalities in GP services across England’ since GP surgeries which serve ‘working class areas’ receive on average ‘10% less funding per patient’ than practices in more affluent areas.

Mr Streeting said: ‘Thanks to the reforms we’ve made to bear down on wasteful spending, we can now invest the savings in working class communities that need it most.

‘Where towns have the greatest health needs and the fewest GPs, we will prioritise investment to rebuild your NHS and rebuild the health of your community.’

The current formula is supposed to ensure resources are directed to practices based on an estimate of their patient workload, taking into account ‘drivers of workload’ and ‘unavoidable costs’.

But both the RCGP and the BMA have argued for years that it needs to be replaced to accurately reflect the communities that practices care for.

In 2015, our sister title Pulse revealed that NHS England and the BMA were discussing plans for practices with ‘atypical’ populations to be given their own contracts under plans being discussed by GPC and NHS England as part of the latest review.

But changes to the formula had been under consideration since 2007 – just three years after it was introduced, partly because of concerns that practices with atypical populations, or those in deprived areas, do not receive sufficient funding to support them to treat their patient demographics.

Related Article: New training code published for nurses on learning disability and autism

Professor Azeem Majeed, head of the Department of Primary Care and Public Health at Imperial College London, told Pulse that the current formula ‘has not kept pace’ with changing population needs and does not sufficiently account for levels of deprivation or the complexity of care required in more disadvantaged communities.

He said: ‘A properly weighted and adequately resourced funding model is essential if we are serious about tackling health inequalities and ensuring high-quality primary care for all. The announcement of a review of the Carr-Hill formula is therefore very welcome and long overdue.

‘We know that general practices in deprived areas face higher levels of multimorbidity, greater social complexity, and greater demand.

‘And yet NHS funding for primary care has not adequately reflected this. However, it is also essential that any changes to the Carr-Hill formula are accompanied by an overall increase in funding for NHS general practice in England.

‘Simply redistributing a fixed pot of funding risks creating new funding pressures in other areas and undermining services that are already stretched.

‘We need to increase the overall investment in general practice so that patients in deprived communities receive the care they need, without destabilising provision elsewhere.’

NHS England national director for primary care Dr Amanda Doyle said: ‘It is essential that GP practices serving our most deprived communities, where health challenges are often greatest, receive a fair share of resources that reflects their need.

Related Article: Could your nursing team be next to receive a General Practice Award?

‘The NHS is committed to ensuring people can access the help they need as quickly and easily as possible and ensuring funding reflects this will help us to do just that.’

Earlier this year, modelling by two ICBs found that implementing a new GP funding formula based on population need would cost just £333m in England.

A version of this article was first published by our sister title Pulse.