GP funding formula a 'problem' for NHS inequalities, study claims
GPs in Scotland's deprived areas do not receive adequate funding to match their increased clinical demand, research has found.
GPs in Scotland's deprived areas do not receive adequate funding to match their increased clinical demand, research has found.
The study by researchers at the universities of Glasgow and Dundee suggested the Scottish Allocation Formula (SAF) - which determines how funding is shared among GPs - is part of the problem'' of inequalities in the health service.
According to the research, practices in more deprived areas treat more patients with multiple ongoing physical conditions and mental illnesses, with those in the most disadvantaged places treating 38% more patients with multi-morbidity than the least deprived and double the number of patients with combined mental and physical multi-morbidity.
Evidence from the study also showed that although practices in more disadvantaged areas have younger populations, they also have higher levels of complex multi-morbidity occurring at a much younger age.
Multi-morbidity means someone with two or more chronic health conditions, five or more chronic conditions and combinations of physical and mental conditions.
Professor Graham Watt, the Norie Miller Professor of General Practice at the University of Glasgow, said: On average GPs in more deprived areas have a higher workload with 20% more consultations with patients who are more likely to be multi-morbid with both physical and mental conditions, but do not receive additional funding to address these complex needs.
The average NHS spend per patient per annum in the most deprived general practices is £120, compared with £127 in the most affluent half of the country.
When needs are partially met the health service underachieves in reducing the severity and slowing the progression of health and social problems. The consequence is that patients are admitted to hospital and die earlier than they need to.
Until allocation formulas in Scotland and the rest of the UK take into account the earlier onset of morbidity in more deprived areas, such funding systems will remain inequitable and continue to be part of the problem of health inequalities rather than part of the solution.''
The SAF determines how funding is distributed by age and sex of the practice population, as well as additional needs such as morbidity and deprivation, and the rurality and remoteness of the practice.
Despite the SAF taking deprivation into account, the study found that practice funding remains broadly flat, even when deprivation increases.
Prof Watt added: With a flat distribution of funding, practices in deprived areas can only generate increased consultation rates by having shorter consultation times or by working longer hours.
Universal healthcare coverage provides access to care but does not in itself equip frontline practitioners to respond proportionately to patients' clinical needs.''
The researchers restricted their analysis to GP practices in Scotland with no missing data, leaving 956 practices in total, 96.5% of all Scottish general practices.