Flawed PCN funding streams may have contributed to worsening health inequalities in general practice in deprived areas, a report has warned.
The Health Foundation analysed whether PCN policies have widened the ‘underlying gaps’ between GP practices in more and less deprived areas, and concluded that imbalanced funding mechanisms may have affected practices in highly deprived areas.
Their research pointed out that the opportunity to use PCNs to reduce health inequalities between the richest and poorest areas ‘hasn’t been fully realised’ and that the ‘skewed funding’ is ‘particularly concerning’.
With new funding contracts for PCNs and GPs currently being negotiated, the Foundation is urging NHS England to ‘reform its funding formulas to ensure PCNs in areas of high deprivation receive the funding they need’.
The report, which was published today, said: ‘General practice in England is under growing pressure. This is often most acute in more deprived areas, which have fewer doctors and less funding compared with practices in wealthier areas after accounting for health needs.
‘When adjusted for the higher needs of local patients, PCNs in the 20% most deprived areas of England employ six fewer full-time equivalent staff per 100,000 patients than those in the 20% least deprived areas.
‘PCNs in the most deprived areas would collectively receive £18.6m more funding per year if all population-based PCN funding streams used in the available allocation formula that best accounts for deprivation.’
The research warned that PCNs in areas of high deprivation ‘need funding that meets the greater needs of their populations’.
‘In the short term, NHS England should base all PCN funding and workforce allocations on the PCN-adjusted population, which better accounts for need,’ the report added.
‘In the longer term, funding allocations for core general practice services, as well as staffing and resource allocations for PCNs, should be changed to better align with need.’
The report also pointed out that PCNs ‘cannot be separated from their constituent practices’ and recommended that policymakers ‘must take steps to address the longstanding inverse care law in core general practice funding and staffing’.
This should include an independent review of general practice funding allocations, with a commitment to implementation of its recommendations, according to the researchers.
Dr Rebecca Fisher, a GP and a senior policy fellow at the Health Foundation, said: ‘General practice in the poorest areas, where people have the greatest health needs, is missing out on much needed funding and additional staff.
‘Without this, the health of people in more deprived areas risks falling even further behind other parts of the country.
‘People in poorer areas need to have better access to GPs and other primary care professionals.
‘Renegotiation of primary care contracts, currently being led by NHS England, is an opportunity to address this issue.’
Last year, the GPC committed to policy that PCNs pose an ‘existential threat’ to the independent
contractor model – two years after England’s LMCs had voted in favour of a similar motion.
And the BMA set out that it wants PCNs to evolve into ‘locally flexible neighbourhood teams’ as the vehicle for collaboration between local GP practices.
Earlier this year, the Health Foundation warned that GPs in the UK experience the highest levels of stress and have the lowest job satisfaction compared to doctors in other high-income countries.
Why is this news? GP practices in the less leafy areas have been underfunded for decades, so why has nobody protested
sufficiently; just for example QOF targets for decades never improved the health of people and the funding in the neediest poorest areas to the same extent as the already wealthiest GP practices. Dr Rebecca Fisher is so right about underfunding, iniquitous underfunding, so why does it take so long for someone to recognize and speak up about these issues at the Health Foundation and in the NHSE? Are their advisors and their statistics not telling them the right things? Or is it plain ‘Deaf Ears’?
Patients penalised for being so poor and unhealthy; a scandal that this is allowed to happen. Doubtful if Tories will change it.
Also, can Dr Fisher bring about a financial transformation to advantage the poorest and even the medium poor for a change?
Let’s all hope so.
The only beneficiaries of PCNs are their Clinical Directors and Managers.