And the Decisions That Will Matter Most

By Kirsty Morris

General practice has long known that reform was coming. What is now becoming clearer is not just that change is inevitable – but where the pressure will land when it does.

Recent documents linked to the government’s 10-year health plan have revealed thinking behind a review of the Carr-Hill funding formula. While the formula itself is widely accepted as outdated, the proposals being explored go far beyond a technical recalibration.

They point towards a future in which funding is more conditional, more targeted, and more closely linked to outcomes, patient experience, and workforce participation.

For GP Partners, this marks a significant shift – one that will influence not just finances, but leadership, structure, and staffing decisions across practices.

From Redistribution to Risk

At its simplest level, Carr-Hill reform aims to address long-standing inequalities in how resources are allocated. Few would argue with that principle.

But the emerging proposals suggest a more radical direction of travel, including:

• A greater proportion of GP funding being held outside the core contract
• Targeted incentives for enhanced services and staff participation
• Exploration of outcome-based or proxy outcome-based payments
• Potential links between funding and patient experience measures, such as waiting times

In effect, this represents a shift from a predominantly workload-based model towards one that places greater emphasis on need, delivery, and outcomes.

With that shift comes risk.

Any move away from stable, predictable funding creates winners and losers – something acknowledged openly in the working group reports. Transitional protections may soften the impact, but they do not remove the underlying reality: practices will carry more responsibility for performance variance.

What Outcome-Linked Funding Really Tests

Outcome-linked or experience-influenced payments do not operate in isolation. They expose the systems behind the service.

They test:

• Operational efficiency
• Workforce resilience
• Leadership capability
• Decision-making under pressure

When performance is measured more visibly and rewarded more selectively. Weaknesses that were once absorbed by the system become harder to hide.

This is not simply a clinical issue. In many cases, it is a management and leadership issue.

The Growing Importance of Workforce Decisions

In this context, decisions about people – clinical and non-clinical – take on greater strategic weight.

Practice Managers, Operations Leads, and senior non-clinical roles become pivotal. They are no longer just maintaining systems; they are enabling adaptability, consistency, and delivery in a more demanding environment.

Equally, clinical recruitment decisions must balance more than immediate capacity. Skill mix, complementary strengths, leadership potential, and sustainability all matter more when the margin for error narrows.

A single weak appointment may not cause immediate failure, but it can quietly undermine performance at precisely the time when scrutiny increases and flexibility reduces.

Reform Changes the Cost of Getting It Wrong

Historically, many practices have absorbed inefficiencies through goodwill, personal sacrifice, or informal workarounds.

• Future funding models may be less forgiving.
• When income is more closely tied to delivery, experience, and participation:
• Delayed decisions cost more
• Underperformance lasts longer
• Firefighting becomes harder to sustain

This doesn’t mean practices must become risk averse. It means they must become deliberate.

Planning for a Less Cushioned System

None of this suggests that reform is inherently negative. Many practices may benefit significantly from a more needs-based approach.

But it does suggest that:

• Leadership capability will matter more than ever
• Management roles will carry greater influence and accountability
• Recruitment decisions will shape resilience, not just capacity
• The practices that adapt best are unlikely to be those that simply work harder, but those that are structurally prepared.

Questions for GP Partners to Consider

As the direction of travel becomes clearer, some questions are worth asking now, before change is imposed:

• If funding becomes more outcome-linked, where are our operational vulnerabilities?
• Do our management and leadership roles enable progress, or quietly constrain it?
• Are we appointing for familiarity and comfort, or for complementary strength?
• Which roles in our practice would matter most if pressure increased tomorrow?
• Are our recruitment decisions helping us prepare for the future, or manage the present?

General practice has always evolved. The next phase may simply require a clearer, more intentional approach to how decisions are made – and who is entrusted to carry them.

Get in touch with our team, here.