Quality points lower in poorer areas

Low quality scores in deprived areas are likely to exacerbate health inequalities in the UK, writes Nick Bostock

Quality framework data from England and Wales show that practices in deprived areas are likely to score fewer GMS quality points than practices in affluent areas.  

In Wales, four local health boards with the highest rates of deprivation averaged about 50 points below the national average score of 1,003 points (GP, 22 September).  

This supports findings from research by the University of Manchester’s National Primary Care Research and Development Centre, which found that in 2004/5, English practices in the most deprived parts of the country scored 11 per cent fewer quality points on average (GP, 7 April).  

Deprivation link  

GPs agree that the link between deprivation and quality scores does exist. But there are differing views on whether it is a problem, and how it should be addressed.  

National Association of Primary Care chairman Dr James Kingsland said: ‘The link between deprivation and lower quality has been around for a long time. PMS contracts were one of the measures introduced to tackle this, and the prime minister has said this is the goal of APMS contracts.  

‘These results show that APMS and PMS have not been used enough.’  

He said that in areas where PMS and APMS contracts were used, they were often too similar to the standard GMS template.  

‘PCTs need to look at local needs and contract services to meet them, though this may not mean anything like the quality framework,’ he added.  

NHS Alliance GMS contract lead Dr David Jenner said primary care organisations (PCOs) should investigate the link between lower scores and deprivation. He said PCOs should employ banks of locum GPs and nurses where necessary to ‘parachute in support’.  

Low scores in deprived areas could be seen as compounding health inequalities by cutting practice income. Without allowing for the effects of prevalence weighting on pay, practices in deprived parts of Wales earned around £11,000 less than practices in well-off areas in 2005/6.  

DoH clinical director for primary care contracting Dr Mo Dewji said practices across the UK should be paid the same for the same work, and that deprivation weighting in global sums and prevalence weighting on quality pay should address this.  

Quality scores concern  

He said the link between lower quality scores and deprivation was a concern: ‘Is it right for patients in deprived areas to have practices that may not be doing as well?’  

He added that the differential in quality was small and had decreased since the quality framework was introduced.  

BMA Northern Ireland chairman Dr Brian Patterson agreed that lower quality scores could compound inequalities.  

GPC deputy chairman Dr Laurence Buckman said deprived practices were compensated, despite working harder for fewer quality points. ‘Deprivation income comes from the global sum formula. Prevalence is a fairer weighting to use than deprivation on quality.’ 

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