The Carr-Hill formula sits at the heart of GP funding, yet few people fully understand how it works, or the impact it can have on individual practices. In this episode, Ben is joined by Dr Matt Jones, GP Partner in Cardiff, who has spent years investigating the formula after discovering significant funding differences between seemingly similar practices. Drawing on Freedom of Information requests, published papers, and detailed analysis, Matt explains why Carr-Hill remains such a controversial issue and why a long-awaited review could have major implications for general practice.

Together they explore how the formula's different indices interact, why some practices can lose out by hundreds of thousands of pounds each year, the role of deprivation and fixed costs, and how funding inequalities can affect workforce capacity, patient access, and sustainability. Matt also shares his thoughts on what meaningful reform could look like and why greater transparency is essential if practices are to understand the challenges they face.

Introduction (0:09)

How did you become interested in the Carr-Hill formula? (0:19)

What prompted your research and submissions to the Welsh inquiry? (1:05)

Why is understanding Carr-Hill so important ahead of the current review? (1:54)

Is the problem really about deprivation, or is it more complex than that? (2:45)

Which parts of the formula have the biggest impact on funding? (3:18)

Why are some of the formula's deprivation measures now outdated? (4:12)

How do the different Carr-Hill indices compound to create large funding gaps? (6:14)

Do practices actually know their Carr-Hill scores? (7:49)

How large can the funding differences between practices be? (8:43)

Why do funding inequalities become harder to fix over time? (10:17)

What happens if the formula is adjusted to better reflect current deprivation? (11:31)

Does Carr-Hill underestimate the fixed costs of running a GP practice? (12:42)

Why does the age and sex index potentially exaggerate funding differences? (13:24)

How do fixed costs reduce clinical capacity in lower-funded practices? (14:27)

What changes could make the funding model fairer? (15:50)

Should national pay uplifts be separated from the Carr-Hill formula? (16:59)

Why are funding inequalities continuing to grow? (17:57)

What does this mean for access targets and patient care? (19:18)

Could funding be based on workload instead? (20:24)

What would Matt like to see from the Carr-Hill review? (22:11)

Why transparency around funding matters for practices and patients (22:50)

Closing thoughts (24:11)

Read Matt Jones' paper here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

The proposed Single Neighbourhood Provider Contract could significantly reshape how services are commissioned and delivered at neighbourhood level, but with many details still to be confirmed, PCNs are being faced with important decisions now.

In this episode, Ben Gowland is joined by Robert McCartney, Senior Associate at Hempsons, to discuss what we know so far about the SNP Contract, the growing focus on neighbourhood footprints, and how local PCN DES variations could provide opportunities for PCNs to begin implementing change without waiting for national guidance.

They explore the practical steps PCNs can take to strengthen their position, including leadership, governance, incorporation, and service redesign. Robert shares why proactive PCNs may be best placed to influence the future of neighbourhood working, maintain control of local services, and demonstrate their ability to lead change across their communities.

Introduction (0:08)

What are PCNs and practices asking for support with right now? (0:41)

Why are some PCNs preparing for the future while others are taking a wait-and-see approach? (1:25)

What impact are funding changes having on PCNs and workforce planning? (2:46)

What is the Single Neighbourhood Provider (SNP) Contract? (4:09)

How could neighbourhood footprints affect PCN boundaries and membership? (6:01)

Can multiple PCNs work together under a neighbourhood model? (7:44)

Does collaboration increase the risk of another organisation holding the contract? (9:13)

What do the new PCN DES local variations mean for practices? (10:39)

Could local DES variations reduce the need for an SNP Contract? (11:11)

What opportunities do local variations create for service redesign? (13:47)

How do local variations differ from the SNP Contract? (14:50)

What should PCNs be doing now to prepare for the future? (17:44)

How can proactive leadership help PCNs retain influence and control? (19:58)

What practical steps should PCNs take to implement neighbourhood working? (20:36)

Do PCNs have the leadership and management capacity needed for change? (22:18)

Is incorporation necessary to prepare for the SNP Contract? (23:55)

When does setting up a company make sense for a PCN? (24:17)

Can federations provide an alternative to incorporation? (26:20)

How long does incorporation take and what are the common mistakes? (27:56)

Visit the Hempsons website here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this episode of the General Practice Podcast, Ben is joined by Dr Sian Stanley, GP Partner, PCN Clinical Director and Health System Transformation Leader to explore how general practice can play a central role in reshaping urgent and community care.

Sian shares the story behind a GP-led urgent treatment centre collaborative in West Essex, bringing together primary care, community services, the acute trust and wider system partners to redesign patient flow and reinvest savings back into local services.

This is a fascinating discussion about practical system leadership, collaboration, and the future role of general practice in NHS transformation.

Introduction (0:09)

Tell us about your roles (0:23)

Tell us about the urgent treatment centre and why it's unusual for primary care to lead it (1:38)

How does the funding and profit-sharing work within the collaborative? (3:27)

Is the hospital involved in the collaborative? (4:42)

How does making "left shift" tangible help bring practices on board? (6:15)

Is it difficult balancing system leadership with representing practices? (7:16)

How do you reassure practices and keep them engaged? (7:50)

What is the relationship with the acute trust and how has it developed? (10:04)

What impact has the loss of ICB funding had on these roles? (11:28)

How do you see the provider collaborative developing? (12:23)

Is there nervousness about acute trusts becoming too powerful in community care? (13:47)

How do you stop general practice becoming an extension of the acute trust? (15:01)

How are you tackling the "substitution effect" around hospital admissions? (17:55)

Are you starting to see shared savings models work in practice? (21:14)

How did you build influence and get a voice at the table? (23:48)

Closing reflections (26:24)

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this week's episode, brought to you in partnership with Practice Index, we welcome back podcast regulars Claire Houston & Robyn Clark to unpack the realities of the 2026/27 GP contract and what it means for general practice. Claire & Robyn share practical insights into how practices are managing rising expenses, the limitations of current funding allocations, and the increasing challenge of balancing demand with limited resources. They also reflect on wider system issues, including the sustainability of general practice, the risks of shifting workload without adequate funding, and the growing tension between policy expectations and operational reality.

Introduction & Sponsor (0:09)

Immediate Impact of Contract Changes (2:00)

Capacity & Access Funding Changes (9:30)

Barriers to Recruitment & Delivery (10:30)

Advice & Guidance Changes (17:16)

Referral Management & System Pressures (19:09)

QOF & Childhood Immunisations Update (24:23)

Support Available via Practice Index (26:42)

To visit the Practice Index website, click here or contact James Dillon here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this week's episode, Ben is joined by Dr Sarah Coope, former GP, mediator and CEO of Wild Monday, to explore one of the most challenging aspects of working in general practice - conflict. Sarah shares why conflict is both inevitable and, when handled well, a positive force within teams, particularly in high-pressure environments like general practice and PCNs. The conversation explores why unresolved conflict is so common, how workload and system complexity contribute, and why avoiding difficult conversations can often make things worse. The episode also highlights the emotional toll of conflict, the importance of psychological and emotional safety, and why one-to-one conversations are often more effective than large group discussions. Finally, Sarah discusses the support available for leaders, including coaching, peer networks and structured development programmes.

Introduction (0:07)

Why conflict is common in general practice (1:15)

The impact of pressure, workload and system complexity (2:27)

Avoiding conflict and why it can be harmful (4:02)

The emotional toll of conflict (5:14)

Handling personal conflict and strong emotions (8:50)

Expressing how situations feel (11:00)

One-to-one vs group conversations (12:36)

Structuring the conversation: HiFIVE model (13:50)

Challenging assumptions and narratives (15:05)

The final part.. (20:06)

Summarising the HIGH5 framework (22:43)

Supporting leaders with conflict (23:03)

Visit the Wild Monday website here.

Access the HiFive model here.

The Shapes Academy Toolkit can be found here.

Access the How To Lead Without Rescuing webinar here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

Ben recently joined Tara Humphrey from THC Primary Care on The Business of Healthcare Podcast, to explore what lies ahead for primary care, the importance of strong relationships in leadership, and what recent GP contract developments mean for Primary Care Networks and neighbourhood-focused approaches. Interested in hearing more from Ben and Tara? Join them at PCN Plus LIVE 2026 on Wednesday 22nd April 2026, where they'll be focusing on how deeper collaboration, locally driven innovation, and bold thinking can shape the future of healthcare delivery. Visit the website here to learn more or secure your place.

Introduction (00:55)

"Make it easy to work with you" (05:28)

Being intentional vs organic in networking (07:56)

Writing emails that get responses (09:56)

The GP Contract: first reactions (11:41)

Are PCNs at risk? (19:10)

Moving from discussion to action (24:19)

PCN Plus Live 2026 (25:19)

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this week's episode, brought to you in partnership with Practice Index, we welcome back to the podcast Peter Maynard, Executive Partner at Horfield Health Centre and Ceri Chaplin, Managing Partner at Hereford Medical Group. Following the publication of the 2026/27 GP contract, they discuss the headline changes and what they could mean for general practice. While the announcement highlights new investment, the reality for practices may be more complex, with funding pressures, operational changes and unanswered questions about how the proposals will work in practice.

The conversation explores the implications for practice finances, workforce recruitment, PCNs, advice and guidance, performance management and quality frameworks, alongside the practical challenges managers face when implementing national policy locally.

As always, the details still need to emerge, but this episode provides an early perspective on the potential risks, opportunities and uncertainties facing general practice over the next year.

Introduction (00:49)

Initial reactions to the GP Contract (01:17)

Funding and the headline investment (03:10)

Capacity and Access funding changes (06:39)

Changes to ARRS funding (09:44)

The future of PCNs and neighbourhood working (11:12)

Advice and Guidance becoming core work (13:44)

Increased expectations and performance management (17:58)

QOF changes and obesity management (21:10)

Childhood immunisation targets (22:57)

What happens next? (24:31)

To visit the Practice Index website, click here or contact James Dillon here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this week's episode, Ben is joined by Dr Freddie Charrington, GP Partner at Phoenix Health Group in Tetbury, to discuss the growing financial challenges facing dispensing practices, and how the practice transformed its dispensary from near break-even to sustainable profitability. Freddie shares how he unexpectedly became dispensary lead soon after becoming a partner and was tasked with determining whether the service should continue at all. Working alongside his dispensary team, family members and a data scientist, Freddie developed 'Dispensary Market', a tool that compares drug prices across multiple wholesalers, helping practices make smarter purchasing decisions. Freddie also explains how the tool has expanded beyond his own practice, remaining free for GP practices while helping improve both profitability and medication availability across dispensing sites.

Introduction (0:08)

Freddie's background and becoming dispensary lead (0:20)

Why dispensing practices are under financial pressure (1:21)

Rural challenges and workforce pressures (2:27)

Discovering the true dispensary finances (3:07)

Identifying purchasing inefficiencies and drug margins (4:01)

From spreadsheets to building a solution (4:45)

Developing Dispensary Market (5:27)

Expanding wholesalers and improving margins (6:30)

Implementing change with the dispensary team (7:21)

How the platform works in practice (8:24)

Why drug prices change constantly (9:24)

Real-time pricing and system design (10:10)

Early results and product evolution (10:44)

Lessons in change management and user adoption (11:44)

Rolling out to other practices (13:23)

Keeping the platform free for GP practices (14:43)

What is 'Dispensary Market' and how to access it (15:08)

Uptake and current usage (16:11)

Balancing GP work and running the platform (16:21)

Supply chain benefits and stock availability (17:06)

Closing reflections (18:10)

Check out the 'Dispensary Market' website here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this week's episode, brought to you in partnership with Practice Index, we welcome back podcast regulars Claire Houston & Robyn Clark to explore why appraisals are a vital part of staff development in general practice, and how to make them meaningful rather than just a tick-box exercise. They discuss whether 'appraisal season' is helpful or whether reviews should be spread throughout the year, how to structure objectives so they align with wider practice goals, and why appraisals should never contain surprises. The conversation covers practical tips on preparation, 360° feedback, handling difficult conversations, and setting SMART objectives that genuinely support both individual growth and organisational strategy. The episode also explores the unique challenge of appraising practice managers, the benefits of a four point scoring system, and how digital tools like the Appraisals Manager within the Practice Index Hub can streamline the entire appraisal cycle, from scheduling and documentation to tracking objectives and progress.

Introduction (0:09)

Practice Index Appraisals Manager: what it offers (00:35)

Is there such a thing as 'appraisal season'? (01:25)

Why appraisals should never contain surprises (02:15)

Formal appraisals (03:10)

Aligning individual objectives with practice strategy (04:00)

Setting meaningful objectives (and how many to set) (06:30)

Using SMART objectives effectively (08:30)

The importance of preparation and pre-appraisal questionnaires (10:30)

360° feedback and gathering wider perspectives (11:30)

Avoiding difficult conversations, and why you shouldn't (13:45)

A practical structure for giving constructive feedback (14:45)

Rethinking scoring: why move from five points to four? (16:50)

Documenting objectives and tracking progress digitally (18:20)

Who appraises the practice manager? (19:15)

Using the IGPM appraisal toolkit (20:30)

Accessing the HR package and Appraisals Manager in the Hub (23:30)

Episode summary and close (24:30)

To visit the Practice Index website, click here or contact James Dillon here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.

In this episode, Ben is joined by Catherine Pope, Professor of Medical Sociology at Nuffield Department of Primary Care Health Sciences, to explore how access to general practice really works in practice and what happens to appointment systems over time. Drawing on over 30 years of research and findings from a recent study, the discussion examines the sustainability of different access models, the legacy of initiatives such as Advanced Access, and why practices continually adapt systems to manage demand. The episode explores the limitations of top-down, standardised and digital first solutions, the impact of access systems on patients, reception teams and clinicians, and why variation is often necessary to meet the needs of local populations. The conversation also highlights patient experiences of navigating access, the risks of diversion and looping between services, creative approaches such as the 'Phones and Ladders' game to illustrate access challenges, and the case for more patient-centred, locally adaptable models that prioritise need, continuity and sustainable general practice.

Introduction (00:08)

Your recent study on access to general practice (01:00)

Did you find that practices were able to sustain the benefits of new access systems? (04:04)

Have practices managed to stick with the changes they made over time? (09:41)

Does this impact sustainability, because eventually people stop doing it? (13:39)

'Phones and Ladders' (15:30)

Should access start with local population needs? (19:28)

Are current access outcome measures too crude if they focus only on waiting times? (22:05)

If people want to access the research or learn more, where can they find it? (24:33)

Visit the 'General Practice: Innovation, impact and sustainable change' research here.

For all enquiries about the Ockham podcast, please contact Ben Gowland here.