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GPs' quality workload is linked to poverty

The importance of weighting quality payments against practice disease prevalence has been hammered home after Government statistics showed a clear link between deprivation and several quality markers.

Data released last week by the Office for National Statistics proved GPs in deprived

areas would lose out under the framework unless the pay weighting was applied.

The study, based on clinical data from 199 practices in England between 1994 and 1998, found the prevalence of coronary heart disease, stroke, depression, anxiety and non-insulin dependent diabetes ­ all covered by the quality framework ­ increased significantly as deprivation rose.

Age-standardised prevalence of CHD, anxiety, schizophrenia and non-insulin dependent diabetes increased significantly using both indices of deprivation in the study ­ the Townsend index and the index of multiple deprivation 2000.

Professor Richard Baker, professor of quality in health care at the University of Leicester, said the results proved practices serving deprived communities needed extra resources. 'They are going to have more difficulty in reaching the targets.'

Professor Martin Roland, director of the National Primary Care Research and Development Centre, who advised on the quality frame- work, said: 'If payments are intended to reflect the workload requirements then the best reflection of that would be disease prevalence.'

Dr Shiv Pande, chair of the British International Doctors Association and a GP in Liverpool, said many overseas GPs stood to be the biggest losers unless the quality framework was linked to disease prevalence because they tended to work in inner-city practices.

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