Primary care funding disparities by deprivation

#17 — NHS funding mechanisms create perverse incentives, disadvantaging deprived areas for childhood vaccinations.

Public Accounts Committee

Recommendation: We asked about the equity of NHS funding mechanisms and the risk of perverse incentives, using as an example the distribution of money for childhood inoculations. GP surgeries receive a payment for every child that gets a vaccine.29 In our …

Gov response: 4.2 NHS funding allocations (including for primary care) already take account of deprivation and health inequalities. Areas with populations of relatively greater deprivation and higher premature mortality receive a relatively higher level of funding to …

Accepted

#4 — Review NHSE payment systems and processes to incentivise local systems supporting hard-to-reach patients.

Public Accounts Committee

Recommendation: In some cases, NHSE’s payment mechanisms can mean that local systems do not receive financial recognition when they prioritise hard-to-reach patients. GP surgeries receive a payment for every child vaccination. This vaccination funding mechanism favours areas where parents are more …

Gov response: The government agrees with the Committee’s recommendation. deprivation and health inequalities. Areas with populations of relatively greater deprivation and higher premature mortality receive a relatively higher level of funding to recognise greater need and help …

Accepted

#75 — Undertake comprehensive review of National Funding Formula to ensure fair, needs-based allocation.

Education Committee

Recommendation: A comprehensive review of the National Funding Formula is urgently needed to ensure funding is allocated fairly and reflects the real level of need across the country. The current formula fails to address historic underfunding, ignores rising inflation, does not …

Gov response: The overall schools and high needs funding included in the Department’s spending review settlement – an increase of £4.2 billion by 2028–29 compared to 2025–26 – continues the support available for children and young people …

Not Addressed

#20 — Upholding rights and potential of marginalised groups and women should be UK ODA priorities.

International Development Committee

Recommendation: Upholding the rights of marginalised groups, as well as realising the potential of women and girls in both achieving societal resilience and poverty reduction, should be strategic priorities for UK ODA. This must be reflected in the spending allocations. (Conclusion, …

Gov response: Partially Agree 34. The FCDO is transitioning to differentiated development partnerships based on mutual benefit – taking account of country need and long term UK interest. The UK will prioritize our geographic ODA where humanitarian …

No Published Response

#19 — ODA resourcing decisions must prioritise greatest need in fragile and climate-vulnerable states.

International Development Committee

Recommendation: In the coming years, the greatest need will be in fragile and conflict- affected states, and states most vulnerable to climate change. Working in partnership to address these needs mutually benefits the affected countries and the UK. The empowerment and …

Gov response: Partially Agree 34. The FCDO is transitioning to differentiated development partnerships based on mutual benefit – taking account of country need and long term UK interest. The UK will prioritize our geographic ODA where humanitarian …

No Published Response

#11 — Deprived communities and minority groups experience longer elective care waiting times

Public Accounts Committee

Recommendation: In July 2025 NHSE started publishing new data alongside the existing monthly Referral to Treatment Waiting Times data that showed that people from deprived communities and minority backgrounds are more likely to be waiting longer than 18 weeks for care …

Gov response: 1.7 The Elective Reform Plan (ERP) set out several commitments aimed at tackling health disparities in access to and waiting time for elective care, including the publication of waiting list information disaggregated by demographic information, …

Accepted

#20 — Provide free over-the-counter medication for low-income patients through Pharmacy First scheme.

Health and Social Care Committee

Recommendation: To avoid patients continuing to use GPs for support that could be offered in a community pharmacy setting because of concerns about the affordability of over-the- counter medication, we recommend that such medication is free for people on low incomes, …

Gov response: Partially Accept There is no charge connected to accessing Pharmacy First for support on one of the seven specified conditions. If the outcome of a Pharmacy First consultation is a supply of a prescription only …

Partially Accepted

#11 — Pharmacy's potential to improve healthcare access requires substantial public funding and support.

Health and Social Care Committee

Recommendation: We have been encouraged to hear the enthusiasm within the pharmacy profession to deliver more patient facing care. However, the undoubted potential for pharmacy to improve access to health care, crucially including immunisations, and reduce pressure on general practice and …

Gov response: There is no charge connected to accessing Pharmacy First for support on one of the seven specified conditions. If the outcome of a Pharmacy First consultation is a supply of a prescription only medication for …

Partially Accepted

#2 — Overhaul the Community Pharmacy Contractual Framework to address funding gaps and reduce complexity.

Health and Social Care Committee

Recommendation: We recommend that the Community Pharmacy Contractual Framework (CPCF) is completely overhauled, in close consultation with the community pharmacy sector. Any new framework must: a) close the gap in funding that community pharmacy has experienced over the course of the …

Gov response: Serious Shortage Protocols (SSPs) are a tool to manage and mitigate medicine and medical devices shortages. An SSP enables community pharmacists to supply a specified medicine or device in accordance with a protocol rather than …

Partially Accepted

#14 —

Health and Social Care Committee

Recommendation: As part of its national health and care recovery plan, we recommend that the Government sets out the contribution that public health services will make, and ensures that this contribution is backed with a level of funding that acknowledges their …

Gov response: Partially accept. The Government recognises the crucial importance of effective public health services in supporting local populations, and the negative impact that the pandemic has had on health inequalities. Public health services are vital in …

Under Consideration

#13 — Significant regional disparities observed in energy support voucher redemption rates.

Public Accounts Committee

Recommendation: We asked witnesses about the take-up rates for the vouchers. The Department told us that 76% of vouchers had so far been redeemed across Great Britain. It accepted that take- up was lower in metropolitan areas, and that the take-up …

Gov response: 2.1 The government agrees with the Committee’s recommendation. Recommendation implemented 2.2 The government has closely monitored Energy Bills Support Scheme (EBSS) voucher payments to traditional prepayment meter customers in Great Britain and published data regularly. …

Accepted

#5 — Publish analysis of actual NHS dental care costs, reflecting treatment complexity and community deprivation impacts.

Public Accounts Committee

Recommendation: DHSC and NHSE have not undertaken the analysis needed to understand the actual cost of delivering NHS dental care, without which any efforts at reform will fail to address fundamental issues around the affordability of NHS work. The discrepancy between …

Gov response: The government agrees with the Committee’s recommendation. and engaging with the BDA on this work, which the government expects will be published in due course. The government is working to reform the dental system, and …

Accepted

#74 — Ensure National Funding Formula provides fair, sufficient SEND funding reflecting regional need.

Education Committee

Recommendation: The National Funding Formula must ensure that funding for SEND is both fair and sufficient to meet the needs of children and young people across the country. While some geographical variation is to be expected, this should reflect the prevalence …

Gov response: The overall schools and high needs funding included in the Department’s spending review settlement – an increase of £4.2 billion by 2028–29 compared to 2025–26 – continues the support available for children and young people …

Not Addressed

#43 — Insufficient funding and support hinder educational outcomes for disadvantaged post-16 students.

Education Committee

Recommendation: On average, economically disadvantaged students aged 16–19 do not perform as well as their peers or achieve the same educational outcomes. Per-pupil funding drops sharply after the age of 16, creating a cliff edge that limits support for disadvantaged students. …

Gov response: The Department funds financial support programmes for 16–19-year-olds, including the Bursary Fund, and provides participation funding for learners up to 25 with EHC plans. For adults, Learner Support and Learning Support help overcome barriers to …

Accepted

#29 — Outdated police funding formula creates structural gaps for forces amid demographic changes since 2015.

Public Accounts Committee

Recommendation: In its 2015 report on the financial sustainability of police forces, our predecessor Committee recommended that a new police funding formula be introduced in 2016–17.80 In our evidence session, we asked whether changing demographics meant the out-of-date formula had led …

Gov response: 6.5 Changes to police governance, force mergers and the creation of the National Police Service require a new way of allocating funding between forces, aligned with these new structures. The Police Reform White Paper confirmed …

Response Pending

#38 — Revise Carr-Hill formula and PCN funding to better account for deprivation and high need.

Health and Social Care Committee

Recommendation: NHS England should revise the Carr-Hill formula to ensure that core funding given to GP practices is better weighted for deprivation. NHS England must also review new PCN funding mechanisms to ensure that they do not inadvertently restrict funding for …

Gov response: Partially Accept. The Department partially accepts this recommendation. GP practices receive funding from a range of sources, including those distributed according to the Carr-Hill Formula and funding delivered to Primary Care Networks. NHS England keeps …

Not Accepted

#37 — Unfair primary care funding mechanisms exacerbate pressures in deprived areas and entrench regional variation.

Health and Social Care Committee

Recommendation: It is unacceptable that areas already under significant pressure due to high levels of deprivation, ill health and under-doctoring have these pressures compounded by unfair funding mechanisms which fail to take account of deprivation. It is particularly concerning that new …

Gov response: Partially Accept. The Department partially accepts this recommendation. GP practices receive funding from a range of sources, including those distributed according to the Carr-Hill Formula and funding delivered to Primary Care Networks. NHS England keeps …

Not Addressed

#36 —

Culture, Media and Sport Committee

Recommendation: We recommend that the Government review the impact of the place‑ based funding model annually, publishing metrics to ensure that ‘doubly‑ disadvantaged’ neighbourhoods are being fully included in the process. (Recommendation, Paragraph 117)

Response Pending

#33 —

Education Committee

Recommendation: The Department must also acknowledge that due to funding pressures 34% of headteachers are using the premium to plug financial gaps in other parts of their operation. We note the Department’s recent changes to the conditions of the pupil premium …

Gov response: 87. We recognise the pressures schools have faced and have listened to teachers and parents. This Government has announced the biggest funding boost for schools in a decade, which will give every school more money …

Under Consideration

#32 —

Education Committee

Recommendation: The Department must do more to target funding to address attainment gaps, such as that which persistently affects disadvantaged White pupils. This should begin with reform to the pupil premium, which should be weighted to account for persistent disadvantage, including …

Gov response: 87. We recognise the pressures schools have faced and have listened to teachers and parents. This Government has announced the biggest funding boost for schools in a decade, which will give every school more money …

Under Consideration

#31 —

Education Committee

Recommendation: Additional funding for disadvantaged students, including disadvantaged White students, is welcome, but is insufficient and insufficiently targeted and does not always reflect true level of need. This seems to have extended to the Government’s “catch-up” funding, with insufficiently targeted formulas …

Gov response: 87. We recognise the pressures schools have faced and have listened to teachers and parents. This Government has announced the biggest funding boost for schools in a decade, which will give every school more money …

Under Consideration

#30 —

Education Committee

Recommendation: School funding has failed to keep pace with where deprivation is in the country, and as a result schools serving disadvantaged communities, including disadvantaged White communities, have suffered financially. The National Funding Formula promises to correct this, but the formula’s …

Gov response: 87. We recognise the pressures schools have faced and have listened to teachers and parents. This Government has announced the biggest funding boost for schools in a decade, which will give every school more money …

Under Consideration

#11 —

Public Accounts Committee

Recommendation: The Department also highlighted the impact of the new minimum per-pupil funding levels on the distribution of funding. The effect of these had been to shift funding in the direction of schools that had very low levels of deprivation.12 The …

Under Consideration

#10 —

Public Accounts Committee

Recommendation: The Department told us that funding allocations were now catching up with changing levels of deprivation—some areas remained very deprived but were not as deprived as they had been in the early 2000s, while other areas remained less deprived but …

Gov response: 2.2 The national funding formula (NFF) distributes funding for schools fairly, based on the needs of schools and their pupils. This includes targeted funding for schools which have higher numbers of pupils from disadvantaged backgrounds …

Under Consideration

#7 —

Public Accounts Committee

Recommendation: There has also been a relative re-distribution of funding from more deprived schools (those with a higher proportion of pupils eligible for free school meals) to less deprived schools. Between 2017–18 and 2020–21, average per-pupil funding for the most deprived …

Gov response: 2.1 The government agrees with the Committee’s recommendation. Target implementation date: July 2022 2.2 The national funding formula (NFF) distributes funding for schools fairly, based on the needs of schools and their pupils. This includes …

Under Consideration

#3 —

Public Accounts Committee

Recommendation: It is not possible to tell whether individual academy schools are receiving the government’s guaranteed minimum per-pupil funding levels. In 2018–19, the Department introduced minimum levels of schools block per-pupil funding for all schools in England. In January 2020, the …

Gov response: 3.1 The government disagrees with the Committee’s recommendation. 3.2 The department does not collect information from academy trusts in this form and it would not be practicable to collect and publish it for the academic …

Under Consideration

#2 —

Public Accounts Committee

Recommendation: Under the national funding formula, schools that are more deprived have fared worse than those that are less deprived. In 2018–19, the Department introduced a national funding formula with the aim of allocating school funding more transparently, consistently and fairly …

Gov response: 2.2 The national funding formula (NFF) distributes funding for schools fairly, based on the needs of schools and their pupils. This includes targeted funding for schools which have higher numbers of pupils from disadvantaged backgrounds …

Under Consideration

#25 —

Health and Social Care Committee

Recommendation: We recommend that NHS England, together with ICBs and the new Office for Health Improvement and Disparities (OHID), work together to deliver regional and national coordination as the system tackles the backlog in elective care. If the independent sector is …

Gov response: The Elective Recovery Taskforce is working to ensure that innovative solutions to tackling the backlog are adopted across the country to ensure that access to care is not dependent on where you live. This includes …

Under Consideration

#13 —

Health and Social Care Committee

Recommendation: The pandemic has had a negative impact on health inequalities and highlighted the crucial importance of effective public health services in supporting local populations. Public health services are therefore vital allies in tackling the backlog, and we are surprised at …

Gov response: Partially accept. The Government recognises the crucial importance of effective public health services in supporting local populations, and the negative impact that the pandemic has had on health inequalities. Public health services are vital in …

Under Consideration

#17 —

Housing, Communities and Local Government Committee

Recommendation: The geographical inequity of relying on council tax to provide the majority of funding for adult social care is compounded by an out-of-date adult social care relative needs formula. The Government must update the adult social care relative needs formula …

Gov response: Achieving the high quality, personalised care and support outlined in People at the Heart of Care, starts in the home where people live. Wherever possible, care and support should be in a person’s own home …

Under Consideration

#15 —

Public Accounts Committee

Recommendation: Sport England’s 2016–2021 strategy, Towards an Active Nation, aimed to understand and address the barriers to activity for the least active by working with a broader range of partners and encouraging local collaboration. Sport England pledged £250 million, or 25% …

Not Addressed

#20 — Provide detailed statement on NHS funding allocation formula for rural mental health needs.

Environment, Food and Rural Affairs Committee

Recommendation: We welcome the Government’s commitment to provide more funding for mental health and to ensure local mental health spending increases by the same proportion as overall increases in local health funding. Despite this, we are concerned by the possibility that …

Gov response: In order to address health inequalities, NHS England (NHSE) allocates funding to each Integrated Care System using a weighted capitation formula based on the size of the local population and its needs. The formula takes …

Not Addressed

#11 — Ensure administrative barriers do not hinder timely energy support for prepayment meter customers.

Public Accounts Committee

Recommendation: Prepayment meter customers pay for their energy in advance by topping up a meter with a smart card, ‘key’ or cash token. Those on prepayment meters are typically on more expensive energy tariffs due to the cost of the systems …

Gov response: 2.1 The government agrees with the Committee’s recommendation. Recommendation implemented 2.2 The government has closely monitored Energy Bills Support Scheme (EBSS) voucher payments to traditional prepayment meter customers in Great Britain and published data regularly. …

Accepted

#2 — Publish analysis of unredeemed energy vouchers and actions to increase household redemption rates.

Public Accounts Committee

Recommendation: The Department is still not doing enough to ensure that support reaches the two million consumers on prepayment meters. Those on prepayment meters are typically on more expensive energy tariffs due to the cost of the systems used to run …

Gov response: The government agrees with the Committee’s recommendation. Recommendation implemented The government has closely monitored Energy Bills Support Scheme (EBSS) voucher payments to traditional prepayment meter customers in Great Britain and published data regularly. Supplier data …

Accepted

#13 — Inadequate CEIAG funding causing significant disparities and gaps in provision for schools.

Education Committee

Recommendation: The Department’s expenditure on CEIAG provision is around £5,000 per school— falling far short of the estimated £38,000 to £76,000 needed to achieve the Gatsby benchmarks. The expectation on schools and colleges to pay for CEIAG out of their already …

Gov response: The Government partially accepts this recommendation. We welcome the Committee’s focus on the important area of careers provision funding and recognise that there are disparities in provision. As the Committee recognised, we are continuing to …

Accepted

#46 — Develop funding and training strategy to address insufficient LARC provision in general practice.

Women and Equalities Committee

Recommendation: The Government should develop a funding and training strategy to address the lack of LARC provision in general practice, particularly in those areas not covered by a women’s health hub. This should include an assessment of whether the current fee …

Gov response: Long-acting reversible contraception (LARC), as one of the most effective and cost-effective forms of contraception, plays a crucial role in supporting women’s reproductive health by: • enabling women to make decisions on if and when …

Not Addressed

#20 — Ringfencing of Homelessness Prevention Grant funding may detrimentally impact some local authorities.

Housing, Communities and Local Government Committee

Recommendation: We welcome the Government’s decision to increase homelessness funding for 2025/26, including the £192.9 million uplift to the Homelessness Prevention Grant (HPG). However, the decision to ringfence 49% of HPG funding for activities to prevent and relieve homelessness may be …

Gov response: The Government currently spends around £34 billion annually on housing support including around £12 billion in the private rented sector. Local Housing Allowance (LHA) rates, which set the maximum level of support in the private …

Not Addressed

#31 — NHS dental workforce maldistribution creates shocking regional inequalities in access to care.

Public Accounts Committee

Recommendation: It is also clearly the case that NHS dental workforce issues are much more pronounced in some parts of England than others and that this is leading to some shocking regional inequalities in access to dental care.92 At the lowest …

Gov response: 1.5 Reforming the dental contract needs careful consideration and this will take time. In the meantime, the government is addressing the immediate challenges for patients trying to access NHS dental care by delivering 700,000 extra …

Accepted

#8 — Concerns raised over NHS dental contract's UDA rates, incentives, and uncompetitive funding.

Public Accounts Committee

Recommendation: In the written evidence submitted to our inquiry, concerns included that: • UDA rates are linked to the figures used in 2006 which no longer reflect current need.13 Rates vary from practice to practice so dentists in the same location …

Gov response: 1.1 The government agrees with the Committee’s recommendation. Target implementation date: to be advised 1.2 To rebuild dentistry in the long term, work on the government’s ambition to reform the dental contract with a shift …

Not Addressed

#1 — Northern Ireland's public services remain in crisis across health, education, and justice.

Northern Ireland Affairs Committee

Recommendation: Northern Ireland’s public services remain in crisis. Its health service is under immense pressure, with long waiting lists, a struggling primary care sector and an acute mental health situation, in part due to Northern Ireland’s recent history. There are severe …

Gov response: We welcome your assessment on the state of public services, one year on from the previous Committee’s initial report, and recognise that improving public services will not be quick or easy. There are very real …

Not Addressed

#69 — Uprate £6,000 SEND funding threshold annually and establish sustainable, equitable funding model

Education Committee

Recommendation: The current £6,000 notional threshold is outdated and inadequate. It must be automatically uprated each year in line with inflation to prevent further erosion of support for pupils with SEND. This is a necessary correction to address years of chronic …

Gov response: The overall schools and high needs funding included in the Department’s spending review settlement – an increase of £4.2 billion by 2028–29 compared to 2025–26 – continues the support available for children and young people …

Not Addressed

#68 — Current funding for SEND inclusion and £6,000 threshold remain significantly inadequate

Education Committee

Recommendation: It is clear that the current levels of funding provided to schools and multi- academy trusts are inadequate to support the effective inclusion of pupils with SEND. The notional £6,000 threshold is insufficient to deliver good SEN support, placing unsustainable …

Gov response: The overall schools and high needs funding included in the Department’s spending review settlement – an increase of £4.2 billion by 2028–29 compared to 2025–26 – continues the support available for children and young people …

Accepted

#56 — Colleges face significant challenges due to limited and inequitable capital funding.

Education Committee

Recommendation: Colleges face significant challenges due to limited and short-term capital funding. Whilst recent allocations have addressed urgent maintenance needs, the lack of sustained capital investment prevents long-term improvements. The £300 million allocated for 2025–26 is insufficient given the scale of …

Gov response: PLANS ALREADY IN PLACE The Government has committed £6.7 billion in capital funding for education in 2025–26, representing a 19% real-terms increase from 2024–25. This includes £950 million dedicated to skills capital. A key focus …

Accepted

#13 — Competitive bus grant allocation leads to unequal funding, failing to consider rurality.

Public Accounts Committee

Recommendation: The Department’s decision to allocate some grants competitively has meant funding per person varied significantly. On average, mayoral combined authorities received significantly more bus service improvement funding (£34 per person) than county councils (£19 per person).27 We asked the Department …

Gov response: 2. PAC conclusion: The department’s funding for buses has been short-term, fragmented and poorly targeted, hindering effective investment in the sector. 2. PAC recommendation: The department should, in its Treasury Minute response to this report, …

Accepted

#35 — Home Office failed to achieve equitable asylum distribution targets, lacking credible plan

Home Affairs Committee

Recommendation: The Home Office has failed to achieve its targets for an equitable distribution of asylum seekers. Asylum accommodation is still heavily concentrated in particular areas, often areas of high deprivation. Many local authorities do not have faith that the department …

Gov response: The Home Office is committed to ensuring that decisions on the distribution of asylum seekers and the identification of contingency accommodation sites are fair, evidence-based, and transparent. Dispersal Accommodation is being managed via the National …

Not Addressed

#5 — Permanently apply ringfence to prevent diversion of NHS dental funding by ICBs

Health and Social Care Committee

Recommendation: We welcome the fact that to try and address the underspend, NHS England is applying a ringfence for 2023/24, to ensure that no ICB can divert funding away from NHS dentistry. We recommend that this ringfence applies permanently, and NHS …

Gov response: Partially accept The Department partially accepts this recommendation. We accept the Committee’s recommendation that we need to build further on the contractual changes we announced in July 2022, to further support and incentivise Dental Practices …

Partially Accepted

#26 — Update Learning Support Fund eligibility to include pharmacists and pharmacy technicians.

Health and Social Care Committee

Recommendation: We recommend that the list of healthcare professionals able to access the Learning Support Fund is updated to include pharmacists and technicians. (Paragraph 140) Pharmacy 47

Gov response: Partially Accept The Committee raises an interesting issue. MPharm students are outside of the scope of the Learning Support Fund (LSF) as it only applies to those courses which were eligible for the NHS Bursary …

Partially Accepted

#25 — Insufficient placements and financial support threaten NHS Long Term Pharmacy Workforce Plan targets.

Health and Social Care Committee

Recommendation: The lack of access to placements, supervisors and adequate financial support is a serious challenge, which could undermine efforts to meet the pharmacy targets set out in the NHS Long Term Workforce Plan. If those ambitions are to be met, …

Gov response: Partially Accept This summer we will publish a refreshed Long Term Workforce Plan to deliver the transformed health service we will build over the next decade, and treat patients on time again. Initial Education and …

Partially Accepted

#19 — Create new Establishment Payment for community pharmacies to develop patient consultation spaces.

Health and Social Care Committee

Recommendation: We recommend the creation of a new “Establishment Payment” to be paid to eligible community pharmacies to support the development of consultation spaces for patients. This funding should be targeted at pharmacies that are the most reliant on NHS work …

Gov response: In line with the ICS People Function guidance (Report template – NHSI website (england.nhs.uk)), the role of pharmacy leadership within ICBs is clear. The development of a one pharmacy workforce approach, within the multidisciplinary team …

Accepted

#1 —

Women and Equalities Committee

Recommendation: Comorbidities pose a risk for BAME people to experience coronavirus more severely and, at times, with adverse health outcomes. To tackle comorbidities, primary prevention should be prioritised. We are concerned that the decision to disband Public Health England could result …

Gov response: The government notes the Committee’s concerns that disbanding Public Health England (PHE) could have on existing health improvement work. Preventing physical and mental ill-health and reducing health inequalities remain top priorities for the government. Alongside …

Under Consideration