It’s time to look again at GP funding

Sian Howell; Payam Torabi

doi:10.3399/bjgp21X714401

The COVID pandemic has shone a spotlight on long recognised inequalities in health outcomes,¹ which have been widening in recent years.² Castle et al³ describe how the general practice funding formula negatively impacts the ability of general practice teams to provide equitable care, with the risk of further widening these inequalities.

The Health Foundation’s recent report Level or Not?⁴ outlines the increased workload for practices serving our most deprived areas. It finds that, once adjustments are made for the associated increased workload in poorer areas, these practices receive 7% less funding per patient than those serving less deprived populations. Unsurprisingly, the report Who Gets In? finds that those living in the most deprived areas are less likely to report a positive experience of general practice care.⁵

Boomla and colleagues⁶ argued back in 2014 for a fairer distribution of funding to reflect the additional workload in deprived areas. Their data on consultation rates for those in the most and least deprived quintiles of multiple deprivation found vastly increased consultation rates in deprived areas. This reflected Marmot’s finding of an 18-year-gap difference in disability-free life expectancy,⁷ and highlighted the need to recognise the very tangible additional workload this brings to general practice teams.

The partnership model, which underpins general practice, involves a single funding stream for partners’ income and patient care. During times of significant challenges for the healthcare system, this can lead to stressful and impossible choices for those working in deprived areas with impacts on recruitment, investment into patient care, and the wellbeing of practice teams.⁸

We would argue that it is time to look again at general practice funding to better reflect the workload involved to meet patient need, and mitigate rather than exacerbate the wide health inequalities so worryingly highlighted in this current pandemic.

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