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NHS Leicester, Leicestershire and Rutland ICB Health Equity Payments Evaluation

Background

The Health Equity Payment (HEP) scheme was developed by population health leads from NHS Leicester, Leicestershire and Rutland (LLR) Integrated Care Board (ICB), intended to be a fairer approach to funding than the current national core GP funding model, which is based on the global sum allocation or Carr-Hill formula. First introduced in 2021 as part of the Primary Care Funding Model (PCFM), the HEP in its current iteration provides additional top-up funding to the most underfunded half of GP practices in LLR, as defined by NHS LLR ICB. The calculations of funding allocations are based on patient needs including case mix, patient list turnover and communication needs, as well as levels of deprivation. The ICB provides HEP funding without spending restrictions or formal reporting requirements, to reduce the burden on practices.

Purpose of the evaluation

The Health Foundation Improvement Analytics Unit (IAU) commissioned the Strategy Unit in February 2025 to support their independent evaluation of HEP patient-level outcomes, by conducting qualitative interviews with participating GPs and practice staff. Interviews were intended to provide insights into how GP practices have spent their HEP funding and share process learning with any stakeholders interested in alternative general practice funding routes.

Methods

Following a scoping stage, which included agreeing the information governance for the evaluation, online interviews (of up to 60 minutes) were conducted between April and July 2025. Twelve practice staff (lead or managing GPs and operational managers) from ten HEP-funded practices were interviewed, having responded to an invitation extended to 77 eligible practices. The practices were sampled by demographic factors, patient population size and level of deprivation and provided services in a range of settings. Interview participants described their understanding, views and experiences and uses of the HEP funding, as well as providing suggestions for the improvement of future HEP or similar schemes.

Findings

• Participants supported the rationale of the HEP model, welcoming it as a fairer alternative to the Carr-Hill formula, which better aligned with local need, though understanding of individual allocations and scheme conditions varied.
• HEP funding was widely valued, with most practices reporting improvements in staffing and access, bringing benefits for patient experience. However, changes to funding allocation amounts in early years posed challenges for planning and recruitment.
• Practices used the funding in a wide variety of ways, reflecting the lack of restrictions imposed on the funding, which practices welcomed for supporting them to make appropriate spending decisions for their context and patient needs.
• Staffing was the most common use of funding, with investment in diverse roles and skill mix seen as central to tackling health inequalities. Some practices hesitated to recruit without longer-term guarantees of increased or recurrent funding or found it difficult to recruit to fixed-term roles. Pooled budgets have been used to address these challenges and mitigate risk.
• Funding also supported targeted service improvements and infrastructure upgrades, though attribution to HEP alone was difficult due to pooled budgets. Reported benefits included reduced call-waiting times, improved screening rates, and enhanced staff wellbeing.
• Participants suggested clearer funding breakdowns, recurrent payments, and improved communication would improve the scheme, with some proposals reflecting existing ICB activity, highlighting the need for continued engagement and awareness-raising.

Conclusions and recommendations

Evaluation findings support NHS LLR ICB’s decision to address limitations in the global sum allocation formula, particularly for practices serving populations with greater health inequalities. While all participants felt funding should continue, some explicitly advocated for this to be delivered through a reformed national core funding mechanism. This echoes the conclusions of other recent reports and the NHS 10-Year Plan, and the evaluation findings support the potential of a national funding model that follows the principles of HEP to lead to meaningful change on a wider scale. Therefore, the following recommendations are made in light of different potential scenarios, including national adoption, the opportunity for similar models to be introduced or adapted in other local systems, or for HEP funding to continue in LLR.

For national-level stakeholders:

• Consider HEP as a pilot for national reform, to address known limitations of existing core funding mechanisms
• Ensure flexibility in funding for any alternative pilot models by removing spending restrictions, mirroring current core funding structures
• For evaluation purposes, align future scheme key performance indicators (KPIs) with existing data collection (such as the Quality Outcomes Framework (QOF) or GP Patient Survey (GPPS) to reduce reporting burden
• Maintain transparency in any future funding changes, with clear practice-level rationale to build trust and accountability
• Promote awareness and share learning from equity-focused funding models across systems.

For NHS LLR ICB and other ICSs:

• Continue to communicate clearly and transparently the funding methodology and rationale
• Provide funding allocations which are stable over longer periods to help practices plan and recruit staff with more confidence.
• Pilot documentation with a sample of practices to gather feedback on clarity of explanations
• Embed engagement into existing forums and tailor support to varied practice capacities
• Offer light-touch data collection and analysis tools to help practices monitor impact and plan with greater confidence
• Use current, locally relevant data and support improvements in coding quality where feasible
• Facilitate peer learning through PCNs and informal case sharing.

For GP Practices

• Strengthen internal data monitoring where possible to evidence HEP or similar funding-related impact
• Share examples of effective use, particularly around staffing and service redesign, through local networks such as PCNs or the LMC
• Engage proactively with ICB communications to stay informed and influence future iterations of the model.