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Practices are paid far less for the same clinical care in deprived areas than in affluent ones

Contract 'highly inequitable'

inequality

The new contract is 'highly inequitable' and pays practices far less for the same clinical care in deprived areas than in affluent ones, a new study reports.

The amount paid per patient on a disease register varies hugely – by up to 44-fold in some cases – the researchers found.

They warned practices in deprived areas were being systematically penalised under the square root system.

A second study by the same team found the contract was doing nothing to narrow the gulf in care between the richest and poorest practices, with divisions much wider than QOF scores would suggest.

Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee, and a researcher on both studies, said: 'The funding formula doesn't provide any incentives to practices serving deprived populations to put extra work into getting patients into more complex care.

'Practices serving a deprived and harder-to-reach population don't get any extra QOF money per patient treated. They do get extra money in the global sum, but that's for the extra burden of routine care and isn't intended to reflect QOF workload.'

The first study, published in November's British Journal of General Practice, found even when excluding outliers, the amount paid per patient varied by 1.5- to 2.7-fold according to prevalence.

The second study, in the Journal of Epidemiology and Community Health, found delivered quality was lower in deprived areas for 17 of 33 indicators examined, largely because of higher rates of exception reporting.

Dr Gillian Braunold, a GP in Kilburn, north-west London, explained the difficulty in incorporating the QOF into inner-city practice.

She said: 'QOF helps look after the worried well in suburban areas by giving them endless MOTs. Doing that is not easy in areas where people are finding it hard to cope in a difficult life.'

Dr Braunold added that exception reporting was a good system in theory, but very difficult to carry out effectively.

Key findings

study 1

• Retrospective analysis of QOF data from 903 practices

• High and low prevalence areas varied by up to 44-fold in pay

• Square root formula 'high inequitable' and perpetuating inverse care law

study 2

• Comparison of QOF scores and indicators of delivered care in 1,024 practices

• In 17 of 33 indicators, quality fell with increasing deprivation

• Exception reporting hides inequity in treatment

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