Equity and the funding of Primary Care Networks.

Abstract

There is a 19-year difference in healthy life expectancy between deprived and more affluent populations in England.1 These health inequities have multiple direct impacts, such as increased disease burden and reduced economic activity.2 Their reduction is an important goal of the NHS Long Term Plan (LTP).3 High-quality and accessible primary care is recognised internationally as an important component of an equitable health system,4 yet there are 15% fewer GPs per capita in deprived areas of England.5 The proportion of the NHS budget spent on primary care has decreased in recent years.6 The LTP promised increased funding to address this.2 Currently, general practice funding in England goes directly to individual practices, according to formulae that include some adjustments to account for workload variation. Rather than directing additional resources into primary care via these existing funding streams, the LTP proposed the creation of new Primary Care Networks (PCNs). These are voluntary groups of practices contracted to work together to deliver additional services for additional funding (technically called a Directed Enhanced Service). The PCN contract offers £1.8 billion extra funding as part of the £2.4 billion increase in overall primary care funding; this is a 14% real-terms increase compared with the £9.6 billion budget in 2014/2015.7 To understand whether this will address or exacerbate existing health inequities and address the so-called ‘inverse care law’,8 it is important to explore how these resources will be allocated and what conditions will be applied to how they can be used. The majority of funding for primary care is distributed through General or Personal Medical Services contracts, with additional payments paid for some specific extra activities.9 The core of practice income is derived from the ‘global sum’, a weighted capitation payment. The average payment of £93.46 per …