As the government prepares to reform GP funding, our evaluation of a scheme in NHS Leicester, Leicestershire and Rutland (LLR) Integrated Care Board (ICB) offers timely insights into what equity-focused investment can look like, the difference it can make and how it can be improved in delivery.

The Health Equity Payment (HEP) scheme was developed by NHS LLR ICB to address longstanding limitations in the national core GP funding formula, known as the global sum allocation or Carr-Hill formula.

First introduced in 2021, HEP provides additional, unrestricted top-up funding to what the ICB determined as the most underfunded half of practices in the region, based on patient need, including deprivation, case mix, turnover, and communication requirements.

Understanding how flexible, needs-based funding works in practice

To understand how HEP has been used and the difference it’s made, the Health Foundation’s Improvement Analytics Unit commissioned the Strategy Unit to conduct a qualitative evaluation, alongside their independent quantitative analysis of patient-level outcomes.

Between April and July 2025, we interviewed 12 staff from 10 HEP-funded practices, sampled for diversity in size, setting, and population need.

Practices valued flexibility and used it to widen access and improve care

Practice staff welcomed HEP as a fairer, more locally responsive model. Many linked the funding to improvements in staffing and patient access, including reduced call-waiting times, better screening uptake, and enhanced staff wellbeing.

They saw the flexibility of the scheme, such as the lack of spending restrictions, as a strength, allowing their practices to tailor investments to their local context. Most funding went toward staffing, particularly roles that broadened skill mix and supported particular patient groups facing greater health inequalities. Practices also invested in service improvements and infrastructure upgrades.

Uncertainty and communication challenges limited impact for some

While HEP’s flexibility was valued, understanding of individual funding allocations and scheme conditions varied across practices. Early changes to funding amounts created uncertainty, making it harder for some practices to plan or recruit. Some hesitated to hire without longer-term guarantees, and fixed-term roles proved difficult to fill.

Pooled budgets helped others to mitigate these risks but made it difficult for them to attribute outcomes directly to HEP. Across the board, participants emphasised the importance of clear communication from funders, recurrent payments, and transparency in funding breakdowns.

Insights for national GP funding reform

The evaluation supports NHS LLR ICB’s decision to move beyond the Carr-Hill formula, especially for practices serving populations with greater health inequalities.

Several participants advocated for HEP principles to be embedded in a reformed national funding model. The evaluation offers timely learning for the current review of GP funding highlighting the importance of:

• Flexible, needs-based allocations that respond to local population needs
• Stable and recurrent funding to support workforce planning and retention
• Light-touch reporting that reduces administrative burden.

More broadly, the evaluation underscores the need for clear communication, transparency in funding decisions, and ongoing engagement with practices to build trust and develop a shared understanding of how equity-focused investment can help create a fairer, more sustainable funding system for general practice.