Equity in primary care

The allocation of funding and the distribution of the workforce in primary care is very unequal in England. Whilst hospital resources have been allocated in relation to a weighted capitation formula in each of the component parts of the United Kingdom since the late 1970s, there have been minimal efforts to equalise the distribution of general practitioners and the budgets which finance them and the services they provide. The purpose of this paper is to illustrate both the existing inequalities in the distribution of primary care funding and the impact of alternative, simplistic but illustrative formulae which could be used as a basis for achieving more equitable funding of primary care in England. These calculations show hat a weighted capitation formula would have a significant impact on the old fourteen regions of the English NHS with major losses in funding and staffing levels in the South, particularly the South West, and major gains in the North of England. For example, using one of the models, the South West would have lost 14 per cent and the Northern region gained over 9% of FHSA expenditure with ‘RAWPed’ primary care budgets in 1990-91. The pursuit of greater equity in primary care funding may require a radical change in the GP contract, perhaps with it being replaced by franchises for primary care which are let to multi-disciplinary teams of providers. Such change requires careful evaluation to ensure that the hospital gatekeeper role of the GP is maintained and the incentives to ensure efficient use of scarce primary care resources are improved.