Workload and funding: nationwide cross-sectional study of general practices in England

<b>Background: </b>Funding based on population need is key to equitable healthcare. The formula for general practice capitation payments in England has not been updated for over twenty years and is based on crude workload weights. <br/><br/><b>Aim:</b> To estimate and describe the uplifts in payments required to bring practices in line with updated and more precise needs-based workload weights.<br/><br/><b>Design and setting:</b> All 6,213 general practices in England in 2024.<br/><br/><b>Methods: </b>We applied updated workload weights to publicly available practice data on patient age and gender, new registration, ethnicity, deprivation and prevalence of 20 long-term conditions. We removed the practice payment provided for input price variation and calculated the current workload payment per weighted-patient for each practice and the funding required to uplift all practices to minimum thresholds. <br/><br/><b>Results: </b>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% (£677.77M per year) and payments per-patient to £99.75 in the lowest and £108.18 in the highest deprivation decile. <br/><br/><b>Conclusions: </b>The workload element of the general practice funding formula should use updated weights. Additional concerns related to equity in outcomes and under-funding of practices in deprived areas should be addressed by adjustments or revisions of other elements of the funding formula. <br/>