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Only way to close health equality gap

From Dr Sean Young, Pontycymmer

From Dr Sean Young, Pontycymmer

I read with surprise your article indicating that new quality cash could end MPIG (News, 9 February). It shows little understanding of how to go about reducing health inequalities. Perhaps the comments made by Dr Hakin indicate that even health care managers have been taken in by the gimmicks and games played by the Government.

A simple understanding of the contract is that it delivers money in different ways. The global sum sets out to ensure practices have the basic resources to provide services, the quality component rewards practices for care delivered and enhanced services rewards GPs for taking on extra work.

A practice working in a deprived area will have high demands to meet, serving a needy population. They will struggle under this workload and, on average, will achieve lower scores for quality. They will also struggle to take on the extra work of enhanced services.

From this it can be relatively easily deduced that money poured into quality will go to practices that are already doing well and will find targets easy to hit. They will also have time on their hands to take on extra work and benefit from enhanced services. Struggling practices in deprived areas will generally fair less well and consequently would not gain extra resources delivered in this manner.

Many of the health reports, such as Wanless, indicate the need to pump prime community services. For those struggling to understand this concept, it means giving resources upfront in anticipation of improved services.

This need is especially important for deprived areas which historically have been under-funded. The bit of the contract that lets you do this is a global sum.

For a health care service committed to reducing health care inequalities the only way forward is to correct the historical inequalities present in health care funding either by removing resources from areas that are over-resourced or by putting extra resources in to the areas of need.

The only way this can be achieved via the current contract is to remove MPIG by ensuring enough resources are available to fund global sums or agreeing with over-funded areas to give up some of their resources so this can be re-distributed.

Delivering resources through any other stream will only further deepen the chasm in provision of health services between the rich and poor.

Removing money from areas that are well-funded is difficult. The last time this was attempted resulted in the MPIG as a compromise.

The best option to resolve this must be ensure adequate funding. Obviously there is some money left for health service development despite the concerns of the Treasury.

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