Lothian LMC / explainers / practice funding
Explainer
The finances of General Practice are complicated, built from a patchwork of payments added over time to solve problems and keep things running. This explainer sets out where the money comes from — and why practice income varies so much.
The core of GP finance is the global sum. Rather than paying every practice the same amount per patient, the global sum is distributed using the Scottish Workload Formula (SWF), which aims to make payments reflect the expected workload of each practice’s registered population, given its particular mix of ages, sexes and levels of deprivation.
The exact mechanism by which the SWF is calculated has never been fully published, but recursive analysis of payment data gives us reasonable insights into how it behaves. It is also important to know that the workload weightings rest on consultation data collected in 2012–13 — and many would argue that consulting patterns have changed significantly since then.
Age is by far the most significant determinant of your global sum. Scottish Government analysis found that patients aged 75 and over generate up to three times the workload of school-age children.
A value of 1.0 represents the workload of the average patient — so a weight of 2.0 means that patient generates roughly twice the expected GP workload of the average patient.
| Age | Male | Female | Interpretation |
|---|---|---|---|
| 0–4 | 1.4 | 1.3 | High consultation rates in infancy |
| 5–14 | 0.5 | 0.6 | Lowest workload group |
| 15–24 | 0.6 | 0.9 | Female reproductive/sexual health increases workload |
| 25–34 | 0.7 | 1.2 | Pregnancy and contraception effects |
| 35–44 | 0.8 | 1.1 | Increasing chronic disease, female consultation rates remain higher |
| 45–54 | 1.0 | 1.1 | Approximate reference population |
| 55–64 | 1.3 | 1.4 | Chronic disease begins to rise sharply |
| 65–74 | 1.8 | 1.9 | Significant increase in multimorbidity |
| 75–84 | 2.8 | 2.7 | Major increase in complexity and contacts |
| ≥85 | 3.8 | 3.5 | Highest workload group |
A multiplier is then applied according to the deprivation profile of the practice population.
| SIMD deprivation | Multiplier |
|---|---|
| Most deprived 10% | 1.10 – 1.15 |
| Deprived 20–30% | 1.05 |
| Average | 1.00 |
| Affluent 20–30% | 0.95 |
| Least deprived 10% | 0.85 – 0.90 |
How the formula shapes practice funding
Relative global sum per patient by practice demographics
Age carries more weight in the formula than deprivation: an elderly affluent population attracts more funding per patient than a young deprived one of the same size.
Whether this is the best method is beyond the scope of this explainer, but it may help practices understand the variations they see in their income compared with other practices.
On top of the global sum, practices receive several additional payments. These include enhanced services, seniority, some very limited payments towards premises expenses and (where applicable) rent reimbursement. There is also an income and expenses guarantee, which attempts to correct for losses arising when the current Scottish Workload Formula replaced the old Scottish Allocation Formula in 2018.
Total payments comprise the global sum plus these additional payments, and the data is publicly available from Public Health Scotland. Processing this data reveals some interesting trends.
Average global sum per patient
By NHS board, 2024/25 — Lothian highlighted
Global sum + additional payments per patient
Excluding premises & dispensing — by NHS board, 2024/25
Island and remote boards receive substantial additional payments reflecting the higher costs of providing services in those settings.
There are many very appropriate reasons for these disparities, and the purpose here is not to create division across Scotland. Few would disagree that a practice serving a remote and rural island community faces very different pressures and costs from an inner-city Deep End practice.
What we hope to do through this piece is improve understanding of how General Practice is funded, and the significant influence the workload formula has on practice income. At some point we will inevitably see a new formula proposed — and it is important to understand the current position so that we are well placed to feed into that discussion.
Curious how your own practice compares? The same public data is available practice by practice in our practice funding benchmarker.
The payments data above shows what comes in; accountant benchmarking shows where it goes. The chart below shows the average Lothian practice’s income of £177.50 per patient, and how it is spent, from benchmarking data for the year ending 31 March 2025. Partnership income is the practice profit — what remains for the GP partners after all other costs are met — and staff costs are broken down by staff type.
Where the money goes
Average Lothian practice, per patient, y/e 31/3/25
| Partnership (profit share) | £73.34 | 41.3% |
| Admin staff | £36.35 | 20.5% |
| Salaried doctors | £21.49 | 12.1% |
| Nursing staff | £12.57 | 7.1% |
| Locums (net) | £2.91 | 1.6% |
| Other staff | £2.94 | 1.7% |
| Premises | £15.83 | 8.9% |
| Medical expenses | £6.64 | 3.7% |
| Administration costs | £4.38 | 2.5% |
| Finance | £0.95 | 0.5% |
| Depreciation | £0.10 | 0.1% |
| Total income | £177.50 | 100% |
“Other staff” is the balance of total staff costs (£76.26) and includes retainers, training and other staff costs. Dispensing income and costs are nil for the Lothian average.
Around 84p in every pound goes on people. Admin staff alone cost more per patient than premises, medical expenses, administration, finance and depreciation combined.
A note on the premises figure. The £15.83 premises slice is an average across practices in very different positions, and should be read with care. Practices that receive rent reimbursement (or notional rent as owner-occupiers) show rent flowing through their accounts as both income and expenditure; practices whose premises costs are managed at source show only their running costs — maintenance, insurance, utilities and the like. The averaged figure is therefore too large to represent running costs alone, yet too small to represent full rent. It is a blend of the two arrangements rather than what any individual practice pays.
Public Health Scotland collects activity data directly from GP clinical systems. Over one year (February 2025 to January 2026), Lothian practices recorded 15.75 million patient encounters — excluding external and undefined activity. Converting that to a per-patient estimate, and pricing the time using the enhanced services staff rates suggested by the BMA, gives a view of what practices actually deliver for their funding.
A year of general practice, per patient
NHS Lothian, Feb 2025 – Jan 2026, priced at BMA-suggested rates
| Staff group | Encounters /pt/yr | Time each | Minutes /pt/yr | Rate /hr | Cost /pt/yr |
|---|---|---|---|---|---|
| GPs | 5.3 | 15 min | 79 | £102.93 | £135.47 |
| Other clinicians (incl. practice nurses) | 4.4 | 15 min | 66 | £35.06 | £38.31 |
| Administration | 6.3 | 10 min | 63 | £19.11 | £20.21 |
| Total | 16.0 | 208 | £193.99 |
Pricing that work
Per patient per year
GP encounter time alone — £135.47 per patient — costs more than the entire global sum before a nurse takes a blood pressure or a receptionist answers a call. Priced at the enhanced services rates the BMA suggests, a year of recorded encounters costs £193.99 per patient — £23 more than everything practices are paid, before a penny is spent on heating, equipment, IT, insurance, training or management. The gap is the work General Practice does for free.