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The Carr-Hill formula sits at the heart of GP funding, yet few people fully understand how it works, or the impact it can have on individual practices. In this episode, Ben is joined by Dr Matt Jones, GP Partner in Cardiff, who has spent years investigating the formula after discovering significant funding differences between seemingly similar practices. Drawing on Freedom of Information requests, published papers, and detailed analysis, Matt explains why Carr-Hill remains such a controversial issue and why a long-awaited review could have major implications for general practice.

Together they explore how the formula’s different indices interact, why some practices can lose out by hundreds of thousands of pounds each year, the role of deprivation and fixed costs, and how funding inequalities can affect workforce capacity, patient access, and sustainability. Matt also shares his thoughts on what meaningful reform could look like and why greater transparency is essential if practices are to understand the challenges they face.

Introduction (0:09)

How did you become interested in the Carr-Hill formula? (0:19)

What prompted your research and submissions to the Welsh inquiry? (1:05)

Why is understanding Carr-Hill so important ahead of the current review? (1:54)

Is the problem really about deprivation, or is it more complex than that? (2:45)

Which parts of the formula have the biggest impact on funding? (3:18)

Why are some of the formula’s deprivation measures now outdated? (4:12)

How do the different Carr-Hill indices compound to create large funding gaps? (6:14)

Do practices actually know their Carr-Hill scores? (7:49)

How large can the funding differences between practices be? (8:43)

Why do funding inequalities become harder to fix over time? (10:17)

What happens if the formula is adjusted to better reflect current deprivation? (11:31)

Does Carr-Hill underestimate the fixed costs of running a GP practice? (12:42)

Why does the age and sex index potentially exaggerate funding differences? (13:24)

How do fixed costs reduce clinical capacity in lower-funded practices? (14:27)

What changes could make the funding model fairer? (15:50)

Should national pay uplifts be separated from the Carr-Hill formula? (16:59)

Why are funding inequalities continuing to grow? (17:57)

What does this mean for access targets and patient care? (19:18)

Could funding be based on workload instead? (20:24)

What would Matt like to see from the Carr-Hill review? (22:11)

Why transparency around funding matters for practices and patients (22:50)

Closing thoughts (24:11)

Read Matt Jones’ paper here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.