RCGP calls on the government to reform GP funding to tackle health inequalities

The Royal College of General Practitioners, The Health Foundation, NHS Confederation's Primary Care Network and National Voices have today called on the government to urgently take steps to reform funding to address the UK's widening health inequalities amid the cost of living crisis.

The joint letter issued to the Department for Health and Social Care calls for dedicated investment and reform to deliver fairer general practice funding that accounts for the regional health disparities seen across the UK.

GPs are on the frontline of a public health crisis: in a 2023 College survey, 73% of GPs reported seeing a ‘worrying’ rise in the number of patients seeking help with problems linked to the rising cost-of-living. There have been further reports from GPs that patients are increasingly asking for support with non-medical items including access to council services and financial advice.

However, the current structure for general practice funding means that typically areas with the greatest patient needs are underfunded in relative terms. The letter warns that general practice funding does not take full account of deprivation and that the Carr-Hill formula, which has been used to allocate core GP funding since 2004, does not equitably distribute funds.

Practices in the poorest areas have 14.4% more patients per fully qualified GP than practices in wealthy areas yet receive 7% less funding after accounting for the additional needs of their local populations.

Practices in areas with the highest levels of income deprivation have on average 300 more patients per fully qualified GP than practices with the lowest levels of income deprivation. This is set against a backdrop of significant national pressures on general practice - on average a fully-qualified, full time GP is responsible for 2,295 patients, 260 more than they were six years ago.

The joint letter is also calling for dedicated investment in workforce expansion programmes that better support and incentivise both new and experienced GPs to work in under-doctored and socioeconomically deprived areas.

Professor Kamila Hawthorne, Chair of the Royal College of GPs said:

"GPs have seen the gap between our richest and poorest patients’ health widen over recent years. We have seen the devastating health effects that poverty and deprivation are having on them made worse by the ongoing cost of living crisis – GPs are reporting that they are spending more time dealing with issues that are directly linked to poverty such as obesity, drug and alcohol misuse and mental health conditions like depression and anxiety. 

"We need to review our funding structures to ensure that the communities worst affected by rising rates of deprivation get the support they need. Currently, we're failing to allocate resources appropriately and our most vulnerable patients are bearing the brunt. GPs and their teams across the country are dealing with intense resource and workforce pressures - but this is being felt more acutely in more economically deprived areas. Where people live shouldn’t dictate the care they have access to and receive.

"Demand for services in general practice is only going to increase and GPs are reporting growing pressures, not just in terms of volume, but also in complexity as patients frequently present with more and more complex conditions. The situation in deprived areas where there are fewer GPs per patient means that there is less ability to provide the continuity of care that our patients from these areas desperately need. The government and all major political parties should heed our calls to address the GP funding structure to tackle growing health inequalities."

Jacob Lant, Chief Executive of National Voices, said: “The maths is simple. The GP practices working in the poorest areas get less money and have fewer doctors. As a result, the patients they serve struggle to get the care they need, compounding the health inequalities they are already experiencing due to lower employment rates, poorer housing, and other factors.

“The resourcing of GPs must be designed to properly reflect the needs of their local communities. This needs an overhaul of funding formulas and mechanisms to ensure the cash flows to where it is needed most and where it will help to narrow the huge gaps we see in healthy life expectancy in this country.”

Aruna Garcea, Primary Care Network, NHS Confederation, said: “Health leaders know that a well-funded NHS supports people’s health and well-being to ensure that they are able to stay well and in good health for as long as possible.

“But we must recognise that overall more people are more are sick than they have been, and they also have greater and more complex healthcare needs, so it is crucial the government starts treating investment in the NHS as an explicit tool of economic development and health improvement so that we can start to move the dial in driving down the stark and growing health inequalities present across our society.

“While there was much to welcome in this year’s GP contract the sad reality is the 1.9 per cent uplift for general practice is simply not enough, we now need to see a renewed and reinvigorated commitment to support primary care, including through additional multi-year investment and to build the strong primary care infrastructure needed to offer a greater range of services to patients fit for the future.”

Dr Becks Fisher, Senior Policy Fellow, The Health Foundation, said: “For almost 20 years policymakers have known that the funding formula for general practice directs money to richer over poorer areas. If government is serious about tackling health inequalities this must change.”

Further information

RCGP press office: 0203 188 7659

Notes to editors

The Royal College of General Practitioners is a network of more than 54,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.