Is the Government serious about levelling up?

Introducing a system that supports deprived practices could be an easy way to show commitment to the cause, says editor Jaimie Kaffash

In true Daily-Mail-headline style, the answer is of course no. But that wouldn’t be much of a blog. So let me explain why – in general practice at least – it seems that supporting deprived practices isn’t at the top of health managers’ agenda. 

The issue of childhood immunisations has caused great controversy in England in the past couple of years, and writing the Pulse Intelligence analysis of childhood immunisations data was illuminating for me for a few reasons.

First, it was a genuine surprise that practices are receiving more money across the country for childhood immunisations than they had under the old system. This is what the BMA GP Committee said would happen at the time in response to the barrage of criticism they were receiving, and it is a strong defence.

Second, we have run stories about practices missing out on thousands of pounds of funding due to missing a few patients. This is undoubtedly true. However, I was unaware that these ‘cliff edges’ were even harsher under the previous system, with even more money at stake for missing out on a couple of patients. In this way, the new system has improved things overall – even if, for some practices, it has made things a lot worse.

Third, it is shocking just how much more the new system benefits practices in the most affluent areas. It might have been something one might expect, but an average practice in the 10% most deprived area is around £130 better off under the new system; an average practice in the 10% most affluent are £1,300 better off.

For me, this third point is perhaps the only consideration. It’s clear that boosting vaccination rates in the most deprived areas must be the priority. But a targets-based approach – where practices receive a huge increase in payments for reaching 70%, 80%, 90% – will always exacerbate inequality because those last patients necessary to get the funding boost are far harder for deprived practices, through no fault of their own.

So if the NHS and the Government is serious about levelling up, this is an easy way to display their commitment: introduce a system that supports deprived practices. This could be payments weighted  towards them, a flat item-of-service fee per vaccination or even – and this is radical – just provide funding upfront to simply administer the vaccinations, with the NHS and Government taking responsibility for the public health aspect of driving up coverage.

But they won’t do that. It’s almost as though they aren’t really serious in levelling up.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk