Introduction
Petition Number: P-06-1505[PW1]
Petition title: Review the Carr Hill formula in Wales
Text of petition:
The Carr Hill Formula was introduced with the new GMS contract in 2004.
It has created enormous, unjustifiable and unsafe funding differences between practices and has never once been reviewed in Wales.
The General Practice Council of England are suggesting a new funding formula is their number 1 priority. However, this is not the case in Wales.
GP Practices get the bulk of their income from the number of patients they have registered with them.
The Carr Hill Formula - which relies on historic data - assigns a number between 0.6 and 1.32 for every GP Practice in Wales.
An average GP practice has around 10,000 patients. If the GP Practice has a 0.6 rating - then they will only get paid for 6000 patients. Whereas, if they have a 1.32 rating - they will get paid for 13,200.
The funding differences between some GP Practices looking after the same number of patients is now very close to £1,000,000. This is absurd and totally unacceptable.
It is time the Welsh Government started looking at the data, reviewing the evidence and allocating resources appropriately.
It is a nonsense to continue to keep pouring money into a system where there is no scrutiny about how it is distributed.
The text provided above is submitted by the petitioner. The petitions team make every effort to ensure it preserves their authentic voice. This text has not been verified for accuracy, or errors, and may contain unverified opinions or assertions.
Mae'r testun uchod yn cael ei gyflwyno gan y deisebydd. Mae'r tîm deisebau yn gwneud pob ymdrech i sicrhau ei fod yn cadw ei lais dilys. Nid yw'r testun hwn wedi'i wirio am gywirdeb, neu wallau, a gall gynnwys barn neu honiadau heb eu gwirio.
1.
Background
The majority of GP practices in Wales are run by independent partnerships of GPs who are contracted by local health boards to provide medical services according to the General Medical Services (GMS) contract[PW2] . As described by the British Medical Association (BMA)[PW3] , the GMS contract payment mechanism is complex, but fundamentally based upon the number of patients registered at a surgery.
Most of a practice’s income comes from the Global Sum payment, which is based on a weighted sum for every patient on the practice list. The Global Sum allocation formula (the Carr-Hill formula) is a complex formula used to apply these weightings, and accounts for factors like age, rurality and gender. Additional funding is then provided towards the costs of things like GP premises, IT systems, and providing certain supplementary services.
Each year, contract negotiations between the Welsh Government, General Practitioners Council (GPC) and NHS Wales take place, which includes agreement on funding.
Stakeholders[PW4] have expressed significant concerns about the Carr-Hill formula, stating that it is outdated and doesn’t reflect population healthcare needs. A 2024 study by Cardiff University[PW5] found that GP practices in more deprived areas in Wales receive discernibly less funding per patient than those in less deprived areas.
Welsh Parliament action
The Health and Social Care Committee is currently carrying out an inquiry on the future of general practice[PW6] . The terms of reference include consideration of the funding model for general practice. Oral evidence gathering will take place in the autumn term.
Welsh Government response
In his response to the Petitions Committee (23 June 2023), the Cabinet Secretary for Health and Social Care said that he was aware of concerns raised by some practices that the Carr-Hill funding allocation does not fully address the demands of their local circumstances.
He highlighted that the funding allocation for general practice is subject to contract negotiations, and said that he was unable to comment further on this petition until the negotiations for the 2025-26 contract, scheduled to commence before the summer recess, have taken place.
Every effort is made to ensure that the information contained in this briefing is correct at the time of publication. Readers should be aware that these briefings are not necessarily updated or otherwise amended to reflect subsequent changes.