Deprived practices hit by prevalence formula

The quality framework ‘institutionalises' the inverse care law and denies deprived practices fair pay, two studies have found.

Analyses of over 1,000 practices in Scotland found the framework discriminated against deprived practices because payments are based on adjusted, rather than true prevalence.

This disadvantages patients in practices with high exclusion rates, said the authors.

The findings, which apply to the whole of the UK, follow a GP investigation this year that exposed skewed payments under the formula and led negotiators to promise a review (GP, 13 October).

The studies published in the Journal of Epidemiology and Community Health and the British Journal of General Practice found that adjusting prevalence creates a 44-fold income difference between practices delivering the same care to the same number of patients.

The  mean difference in practice income between the most deprived and most affluent is £6,012. Even excluding outliers, payments to different practices for the same work vary twofold.

‘We are calling for payments to reflect raw prevalence,’ said co-author Dr Gary McLean, a research fellow in the department of General Practice and Primary Care at Glasgow University.
In a second study, the researchers showed that practices in deprived areas were likely to have higher exclusion rates, up to 35 per cent in some areas.

They said this was because the lower incomes of these practices meant they could not afford to pursue patients who failed to comply with treatment for their diseases compared with more affluent patients. This meant more patients were excluded from quality framework calculations.
GP negotiator Dr Stewart Drage said the prevalence formula would be reviewed in contract negotiations, but added: ‘The profession wanted pay to reflect prevalence, and this was the best available system.’

J Epidemiol Community Health  2006; 60: 917–22

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