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GP funding has “unfair London bias”

Posted on 15 February 2018

New research involving researchers at the University of York has revealed that primary care funding in England is not distributed according to local health needs.


London receives an unfair amount of GP funding according to the study. Image credit: Jasleen Kaur via Flickr

New research involving researchers at the University of York has revealed that primary care funding in England is not distributed according to local health needs.

The study suggests that GP practices in London, where the population is relatively young, receive disproportionately more funding, despite dealing with the lowest level of health needs in the country.

Based on a measure of 19 well-recorded chronic conditions, the researchers calculated that London has a median of 0.38 health conditions per patient.

In contrast, the North East and North West of England have 0.59 conditions per patient and 0.55 conditions per patient, the highest and second highest health needs in England respectively. The median for England is 0.51 health conditions per patient.

Unfair to the North East and North West

Co-author of the paper, Tim Doran, Professor of Health Policy at the University of York, said: “The present formula for GP funding does not provide an equitable distribution of resources across the NHS. It is especially unfair to the North East and North West of England.”

The research team, from the Universities of York, Manchester, Keele, Michigan and Dundee, have also revealed that when health care needs, deprivation and age are taken into account, rural areas receive £36 more compared to urban areas, per patient each year.

The £36 figure is more than a quarter of the median annual primary care spend per patient in England, which was £134 in 2015-16, excluding the cost of prescriptions and drug dispensing.

Practices in rural England tend to look after an older but relatively healthier, more affluent and smaller population, they say, while enjoying similar levels of staffing, when compared to the more hard-pressed practices in urban areas.

The study is the first to evaluate if primary care funding in 2015-16 matched health care needs at geographical areas with an average of 1500 people.

The team examined data from 7,779 GP practices in England, covering 56,924,424 people, over 99% of the population registered with primary care, and publish their findings in the journal BMC Medicine today.

To measure health needs, the researchers created a chronic morbidity index (CMI), calculated as the sum of 19 chronic condition registers in the Government’s 2014-15 Quality and Outcomes Framework, divided by the total practice population.

By linking funding per person with the overall health needs for the 19 conditions, the researchers say the current funding arrangement for GP practices – known as the global sum allocation or Carr-Hill formula – is unreliable and out of date.

Call for a review

The formula, they argue, may excessively favour practices in rural areas, while patient need  - one of the factors on which payment adjustments are made-  is based on a single dimension of morbidity - Long-Standing Illness - from the 1998-2000 Health Survey for England.

Numerous calls have been made over the last decade for the formula to be reviewed, and it is expected to be reviewed by the Government this year.

“The Carr-Hill formula, which is used to allocate NHS funding, is based on a range of data, some of which are inaccurate, unrepresentative or out of date. As a result, it does not accurately reflect the health care needs of local populations” Professor Doran added. “New data sources could provide a fairer allocation of resources.”

Lead author of the paper, Professor Kontopantelis from the University of Manchester said: “If as a society we want a healthcare system which is fair, then we must fund it according to need, and ideally account for the impact of deprivation.

“This study shows that the current allocation of resources to primary care does not do that. The strength of the study lies in the quality of the databases and their sizes. We investigated the whole of England: that’s over 55 million people served by a universal health system.”

Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis is published in BMC Medicine

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About this research

This research was carried out by Professor  Tim Doran from the Department of Health Sciences. The study was partially funded by the Medical Research Council.