New analysis published today by the Health Foundation shows how general practice services in more deprived areas of England are underfunded, under-doctored and, on average, perform less well on key quality measures.
The report, Tackling the inverse care law, details how policies on general practice over the last 30 years have not gone far enough to address major inequities in GP care, known as the ‘inverse care law’ - where people who most need health care are least likely to receive it.
The report describes how repeated promises by policymakers to make funding for general practice fairer – by changing its funding formula (‘Carr-Hill’) – have not been met.
This has undermined other attempts to make provision of general practice fairer – and now threatens the government’s ability to level up health inequalities. The report also highlights the urgent need to boost GP numbers in deprived areas, which have fallen in the last five years.
Compared to wealthier parts of England, people in the poorest areas face a 12-year gap in healthy life expectancy and are more likely to experience multiple health conditions – creating a greater need for GP services in deprived areas.
- Over the past 30 years, governments have tried a mix of approaches to make the provision of general practice fairer. Some policies have helped narrow gaps between richer and poorer areas, but efforts have stalled in the past decade, and inequities are widening. Recent promises of fairer funding have not been delivered – and there is a risk that inequities in care will widen.
- Previous analysis from the Health Foundation (published in 2020) found general practice in poorer areas received about 7 per cent less money per patient than less-deprived parts of the country, once the increased workload and health needs of patients in poorer areas were factored in.
- Health Foundation research published in 2020 found that after accounting for different levels of need, a GP working in a practice serving the most deprived populations was, on average, responsible for almost 10% more patients than a GP in the most affluent areas.
- GP patient survey results from 2021 show that people from the most deprived areas were more likely to report a poor overall experience and were less likely to report that their needs had been met.
Describing the current funding formula for general practice as ‘inadequate’, the report’s authors call on government to conduct an independent review of GP funding allocations as a national priority. They also call for a comprehensive workforce strategy for general practice which includes stronger central coordination and oversight of GP distribution across England.
Rebecca Fisher, Senior Policy Fellow at the Health Foundation, said:
'If the government is serious about ‘levelling up’ the country then tackling underfunding and under-doctoring in GP services in poorer areas needs to be a priority.
‘The current funding system is inadequate and fails to allocate resources based on need. The GP workforce is under pressure everywhere, but more so in deprived areas – where health need is greatest and GP numbers lowest. Policy efforts to address this have stalled in the past decade. Unless the government takes rapid, meaningful action, rhetoric about levelling up will ring hollow.’
The report analyses policies focused on tackling the inverse care law in general practice since 1990. It finds that past governments have used a mix of approaches to try to make the provision of primary care in England fairer – including changes to GP funding, contracts, buildings and staffing. Some policies have had positive effects, showing that policy action can help reduce gaps between richer and poorer areas. But definitive action to address unfair differences in GP funding has not been taken, and overall, efforts to tackle the inverse care law in general practice have stalled in the past decade.
The report’s authors set out recommendations to make the provision of general practice fairer across England. These include an independent review of general practice funding, with a commitment to consider seriously all its recommendations.
They also call for government to work with NHS bodies to develop a medium and long-term workforce strategy for general practice, as part of a broader workforce strategy for the NHS in England. This should include plans to improve GP recruitment and retention, and consideration of stronger central coordination and oversight of the distribution of GPs in England. Despite government’s pledge to increase the number of GPs in England by 6000, there are currently 468 fewer fully qualified FTE GPs in England today compared to 2015.
Current policies on general practice risk widening inequities. To guard against this in future, new national policies for general practice should be subject to an ‘equity test’ to consider how policies impact the fair provision of general practice.
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