Workload and funding in general practice: a nationwide cross-sectional study in England.

Abstract (English)

BACKGROUND: Funding based on population need is key to equitable health care. The formula for general practice capitation payments in England has not been updated for over 20 years and is based on crude workload weights. AIM: To estimate and describe the uplifts in practice payments required to bring them in line with updated and more precise needs-based workload weights. DESIGN AND SETTING: Cross-sectional study assessing the most updated routinely available data on 6213 non-atypical general practices in England with >1000 registered patients and complete information on payments as of 1 April 2024. METHOD: Updated workload weights were applied to publicly available practice data on patient age and gender, new registration, ethnicity, deprivation, and prevalence of 20 long-term conditions. The practice payment provided for input price variation was removed and the current workload payment per weighted patient for each practice and the funding required to uplift all practices to minimum thresholds were calculated. RESULTS: Workload payment per patient was £92.66 on average, varying from £86.72 in the lowest to £99.91 in the highest deprivation decile. Workload payment per weighted patient varied from £81.40 (5th percentile) to £107.10 (95th percentile), and from £89.69 in the lowest to £96.40 in the highest deprivation decile. Uplifting payments to a minimum of £102.46 per weighted patient (90th percentile value) would increase total payments by 11.6% (£677.77 million per year) and payments per patient to £99.75 in the lowest and £108.18 in the highest deprivation decile. CONCLUSION: The workload element of the general practice funding formula should use updated weights. Additional concerns related to equity in outcomes and underfunding of practices in deprived areas should be addressed by adjustments or revisions of other elements of the funding formula.