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Funding for deprived practices under Scottish contract may ‘worsen health inequalities’

Funding for some practices in the most deprived areas of Scotland will worsen health inequalities under the new GP contract, the RCGP has warned.

RCGP Scotland chair Dr Carey Lunan warned that although the new contract promised to ‘address health inequalities’, many deprived areas have not received additional funding to make this a reality, meaning the contract could have the opposite effect. 

Dr Lunan argued funding needs to be based on level of need, not demand.

This comes as a report from the Public Health Observatory found gains in mortality rates stalled across the country between 2012 and 2017, but most acutely in the most deprived areas.

Speaking at a conference on Deep End practices, Dr Lunan said: ‘In Scotland, we are approaching a year since a new contract was agreed by GPs. It was launched with the promise that it would “address health inequalities”.

‘Unfortunately, many practices in areas of high deprivation did not receive the additional funding that others did, which has meant that they are less able to invest in the services they are able to offer patients and less attractive in terms of recruitment.’

‘That discrepancy in additional funding further worsens health inequalities,’ she added.

The RCGP warned actions to tackle the inverse care law are ‘unequal across the UK’.

Deep End practices in Scotland serve the 100 most deprived populations.

The Deep End group was established by Glasgow GP Professor Graham Watt, and is supported by the RCGP, Scottish Government and the University of Glasgow.

When the Scottish GP contract was given the green light by the profession in February 2018, some Deep End practices joined rural colleagues in resigning from the BMA over the workload allocation formula.

They say they have been unfairly disadvantaged by how funding has been calculated.

Through the new contract which came into force in April 2018, GP Clusters have been tasked with ensuring ‘relentless focus on improving clinical outcomes and addressing health inequalities’.

The BMA stressed that income had been protected and no practice had seen a reduction in funding.

BMA Scotland’s GP Committee chair Dr Andrew Buist said: ‘The contract’s refocused GP role to allow more time for patients with complex needs will bring significant benefits to more deprived communities, where patients are often more likely to have multi-morbidities.

He continued: ‘The allocation formula in the new GP contract increased the weighting for deprived and elderly patients in order to better reflect workload and address historic underfunding and no practices lost funding.

‘However, the formula is only one part of the support that the new contract provides to practices with deprived populations.

‘Patients will see significant benefits as multi-disciplinary teams in communities expand by 2021, particularly as link workers are rolled out.’

In 2017, a Scottish Government-funded trial to improve recruitment and retention of GPs in the most deprived practices in Glasgow reported decreased levels of stress and a ‘renewed enthusiasm’ within just six months.

The pilot - designed to counter the impact of the inverse care law by increasing clinical capacity in practices with high levels of deprivation - funded young GP ‘fellows’ in practices four days a week, freeing up senior GP time to take on extra projects which benefit their patients.

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