Eleven rural GP practices have seen their patient lists more than double since 2023, while continuing to be resourced under allocations set on earlier catchment data.
One practice in the north west has gone from approximately 900 registered patients to 2,700, with the same two GPs, the same premises and the same number of consulting rooms.
Why the money does not follow
Practice funding is distributed through a formula weighting registered patients by age, deprivation and rurality. It is a reasonable formula and it does eventually track list size.
The difficulty is the cycle. The underlying dataset is refreshed on a multi-year basis and the next scheduled revision applies from 2028, meaning practices absorb five years of growth before the allocation acknowledges it.
“We are not asking for more than our share. We are asking for our share, calculated on the people who are actually registered with us, which I would have thought was the least complicated request in the health service.”
A GP in a practice whose list has tripled
The demographic shift
Practices report that the change is not only in volume. A significant proportion of new registrations are aged over 60, relocating from areas with denser service provision, and arriving with established conditions and existing care plans.
Those plans frequently assume access to services the area does not have: a hospital within thirty minutes, community physiotherapy, a dental practice taking NHS patients.
The pressure
- Practices with lists more than doubled since 2023: 11
- Largest increase: 900 to 2,700 patients
- Next scheduled allocation revision: 2028
- Share of new registrations aged over 60: around 40% in the affected practices
- Rural GP vacancies nationally: at a record level
The board’s position
The health board has acknowledged the mismatch and made discretionary payments to four of the eleven practices from non-recurring funds.
Non-recurring means it does not repeat, which means practices cannot use it to employ anybody, which means it has been spent almost entirely on locums — the most expensive way to deliver a session and the only one available at short notice.
