Review of Carr Hill Formula Announced

Review of Carr Hill Formula Announced

The Carr-Hill formula is the NHS funding formula used to distribute payments to GP practices based on patient list size and a weighting that accounts for factors like age, gender, and rurality (weighted capitation). It is currently being reviewed because it is based on outdated data and has been criticised for not adequately addressing the needs of patients in deprived communities. A problem the new formula aims to fix by considering patient needs more accurately.

The Carr Hill formula has never really worked since it came into being. A concern many people have is that it is going to focus on deprivation areas only as its core criteria. It needs to, but it does not work in the "leafy" areas like Cheshire very well and the narrative that leafy suburbs are better off is not always true. Colleagues have long studied the 2004 Carr Hill formula particularly how it works in nonurban areas.

The review which could end in a new formula as early as 2026 or 2027 will result in winners and losers. How will this impact your practice on top of all the other financial pressures your practice faces?

In truth it all comes down to funding. Poor funding leads to sustainability issues wherever you are. Those with the worst funding per head are more likely to fall over and hand back their NHS contract. But it can go beyond that. How might that impact your current PCN working if the ICB then put that contract out to tender? If it is currently a GMS or PMS contract it would certainly end up being a time-limited APMS contract. So, this review might impact PCNs as well as individual practices.

If the Carr Hill review just redistributes funding more practices could have real financial problems exposed in areas which have previously been OK. That will inevitably lead to a service which is less GP-led. If the review does not address more than deprivation then it will miss the opportunity to solve the problem. In my view funding must take account of the costs of providing the service you want to provide and not just be a formulaic approach which never worked in 2004 and still does not work today in many areas of the country.

In brief, this is a long-needed reform but one that needs to be done with great care and a proper appraisal of the impact of different practices and areas by those who understand general practice and its finances.

William Greenwood

CEO Cheshire LMC