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The government should commission a review of the Carr-Hill formula to better address deprivation and rurality issues, according to a report by NHS Confederation.
In a report called The Future of Primary Care, NHS Confederation said this move would be part of ‘short-term action to stabilise primary care’ and would be informed by work in Frimley and Leicester, Leicestershire and Rutland ICBs.
It comes after similar calls from think tank the Nuffield Trust, which said in December that the funding model should be replaced with a new ‘needs-based’ system, taking into account younger populations living in deprived areas.
The NHS Confederation report was based on engagement with ICB directors of primary care and looked at what the future system should look like and how to achieve it. It made several short and long-term recommendations to help ‘stabilise primary care’ (see box).
These recommendations also included creating population cohort-based place-level budgets that can support neighbourhood-level services.
It suggested that years of underinvestment had left primary care with ‘inadequate resources’ to meet demand and said funding for general practice in particular had ‘lagged behind’ other NHS sectors, disproportionately impacting deprived areas.
The report also addressed workforce issues saying that ARRS has had a ‘positive impact’ on primary care, but suggested the removal of all role caps associated with the scheme as PCNs should be allowed to recruit the skill mix appropriate for their population.
It said: ‘The future of primary care requires a strategic shift that prioritises accessibility, innovation, and community-centred solutions. Based on insights from our members, we have developed a vision that aims to stabilise and transform primary care.
‘Our vision is to reform primary care, making it the most proactive, personalised and technologically advanced health care system. Building on its strong foundations, it would support citizens to engage in their care, ensure improved, equitable health outcomes for all and deliver a supported, connected workforce that has the resources to enable delivery of high-quality care. It would play a crucial role in putting the NHS as whole back on its feet and on a financially sustainable footing.’
It added that the NHS must work with primary care leaders to achieve this and support the development of the workforce.
It said: ‘By leveraging the capacity and skills within primary care, we can put primary care on the best footing to drive a relational model of care at the heart of a neighbourhood health service; a model which secures the future of the NHS and is led by those best positioned to drive it: the frontline.’
It comes as an increasing number of GPs have been employed through the ARRS scheme, according to the latest monthly primary care workforce statistics.
DHSC should work with (ICSs) to agree on a metric for the care closer to home shift to help national and system leaders assess and report on progress.
Commission a review of the Carr-Hill formula to better address deprivation and rurality issues, informed by the work in Leicester, Leicestershire, and Rutland (LLR) and Frimley.
Support the development and commissioning of primary care at scale providers (primary care provider collaboratives) to provide additional services such as urgent treatment services, diagnostics and day surgery, with greater involvement in ICS elective reform plans.
Reform general medical services regulations to allow limited liability partnerships (LLPs) to hold contracts and update NHS pension regulations to allow LLP partners to contribute to the NHS Pension Scheme. This step will enable general practitioners to limit their individual liability or risk associated with the business. This structure is commonly used in other partnership models, for example the legal profession.
Prioritise reforms in the dental contract to overhaul the use of units of dental activity to incentivise improvements to patient outcomes over volume of activity.
Ensure a new community pharmacy contract sufficiently renumerates activity and medicine costs, and recognises the skills and capabilities that exist, enabling pharmacists to work at the top of their licence. This will unlock innovation and much-needed system capacity.
Create a shared-ownership model for primary and community data that removes the sole data controller responsibility from general practice. This should be grounded in improving data sharing and reducing the administrative burden and risk placed on individual GP practices.
Review the effectiveness of the NHS 111 algorithms and develop a system with primary care at scale with greater capacity to manage risk and improve continuity and patient experience.
Remove all role caps associated with the Additional Roles Reimbursement Scheme (ARRS), allowing primary care networks to recruit the skill mix appropriate for their population.
Reform Section 75 of the NHS Act to enable greater integration and pooled budgets across providers. This would involve allowing a greater breadth of organisations that can pool budgets and greater range of services provided.
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