A new tool to help ICBs allocate general practice funding more equitably – introducing eFIT

Inequalities in access, experience, and outcomes of general practice are driven by structural determinants, namely the distribution of workforce, funding, and workload. Practices in more socio-economically disadvantaged areas have fewer GPs, less funding, patients with more complex health problems at a younger age, and worse patient experiences compared to their more affluent counterparts. We are delighted to introduce eFIT to help Integrated Care Boards (ICBs) allocate funding, taking into account socio-economic status.

General practices have multiple income streams, including capitations, financial incentives, and additional services. Practices receive most of their funding through a formula, commonly known as the Carr Hill formula, which has been criticised for not sufficiently accounting for deprivation.

General practices also receive funding from their ICBs to deliver specific services, such as diabetes or hypertension improvement programmes. Traditionally, ICBs have allocated funding based on the number of people with a specific condition in each practice. For example, for a diabetes improvement programme, practices with more patients with diabetes receive more funding. 

However, practices serving lower socio-economic areas may face greater challenges in delivering a programme compared to their more affluent counterparts, yet they receive the same funding. For instance, a new programme that financially rewards practices for increasing referrals of people with diabetes to the National Diabetes Prevention Programme may be easier to achieve in affluent areas with predominantly white, middle-class, retired individuals who have more time and resources to attend appointments. In contrast, practices in low-income inner-city areas, which serve largely working-age populations, may find it more difficult to achieve the same results. If ICBs allocate funding based on number of patients, without acknowledging additional resources required to deliver services in disadvantaged areas, funding inequalities can be compounded. 

Cambridgeshire and Peterborough Clinical Care Group developed a Health Inequalities Strategy in 2020. As part of this strategy, they developed a tool to help weight local funding by the Index of Multiple Deprivation (IMD). This has been successfully used in Cambridgeshire and Peterborough over the past few years. Colleagues in Cambridgeshire and Peterborough ICB have now developed this tool for use in ICBs across the country; the Extra Funding Allocation Inequality Tool (eFIT). You can access the tool here.

The tool contains data on all ICBs in England, allowing users to enter the funding available and select up to three factors to weight the funding (e.g., IMD, population weight, and diabetes prevalence). The tool will calculate the total allocation for each practice and the equivalent allocation per patient. This allows practices to prioritise indicators and test the impact of different weightings.

We believe this tool will be vital to ICBs as they strive to ensure that general practice funding is allocated fairly, giving additional resources to those practices with patients who need more support.

If you would like to hear more about the tool, please email [email protected].