P-06-1505 Review the Carr Hill Formula in Wales - the funding system for primary care - Correspondence from the Petitioner, 25 September 2025

Good evening,

Thank you for letting me know about the upcoming discussion. I have listened to the oral evidence with some interest. I understand you have received my written submission.

To aid further discussion we have explored fully the distribution of GP funding based on the 6 criteria.

One of the key complaints is that very similar patient populations have wildly different funding via the Carr Hill.

The Excel Sheet attached has every single Carr Hill of each GP practice and matched against this is the “average value” of the patients (according to the Carr Hill formula – see below (1)).

Extremes of age and female sex produce greater workload. (range 1.58-3.3)

Cardiff North GP Practices represent 9 of the bottom 20 funded GP Practices in Wales. We knew this already.

However, now we can see that Cardiff North GP Practice also now represent 9 of the bottom 20 GP practices who are funded the least in comparison to the age/sex of their patients. (This invalidates any argument made that suggests that these GP practices get funded less because they are looking after much younger patients). (2)

This proves that Birchgrove Surgery - for example – who have exactly the “average value” per patient in Wales – a typical patient mix - are funded £290,000 less than an area with the same demographic. Of course – this is only compared to an “average area” – some practices have historically benefitted from much higher funding – in which case the funding gap becomes much larger.

Thank you for the time to read this. I hope this starts to break down why there is so much concern and anger towards the current system.

Dr. Matthew Jones

GP Partner

St Isan Road.

(1) ANNEX B of GLOBAL SUM CALCULATIONS atisn17309doc1.pdf

(2) Copy of Abstract of Article – that has been submitted for publishing.

Dr Matthew Jones

St Isan Road GP Surgery, Cardiff, United Kingdom

Abstract

Background
The Carr-Hill formula underpins general practice funding in the UK. It adjusts allocations based on six factors: age/sex profile, practice needs index, rurality, practice turnover, nursing home prevalence, and market forces. While intended to reflect workload, concerns remain about whether these adjustments deliver fair funding across populations.

Aim
To evaluate whether Welsh GP practices, with a focus on Cardiff North, receive equitable funding under the Carr-Hill formula when compared against age–sex demographic expectations.

Method
Freedom of Information (FOI) data from NHS Shared Services were analysed. For each practice, the weighted list size was divided by the total list size to derive an average Carr-Hill per practice. Separately, expected values based on age and sex were calculated. Practices were plotted on a scatter-graph (x-axis: average age–sex value per patient; y-axis: Carr-Hill score), with a regression line indicating expected allocations. 

Results
Across 370 Welsh practices, 9 from Cardiff North ranked among the 20 most underfunded relative to demographic expectation. For example, practice W97021 had a Carr-Hill score of 0.790 against an expected 0.999, equating to a deficit of over £250,000 annually in a 10,000-patient practice. Cardiff North practices consistently fell below the regression line, demonstrating that patients in this area are allocated significantly less funding than those with identical demographics elsewhere in Wales.

Conclusion
These findings reveal extreme variation in funding for demographically similar patients. A comprehensive review of the Carr-Hill formula is required to ensure fair, workload-based allocation across Welsh general practice.