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GP funding formula masks major inequalities for practices in deprived areas

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7648 (Published 16 December 2014) Cite this as: BMJ 2014;349:g7648

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GP funding formula has a measure of deprivation

Dear Editor,

The GMS funding formula has a measure of deprivation, the Additional Needs Index (ANI). In 2006 we ran a simple regression between the ANI and the Index of Multiple Deprivation for practices in England, the regression coefficient is 0.96.

The ANI has a regression coefficient of 0.78 with the Jarman index, the lowest in the series of regressions including Income Domain, Income Support, AA/DLA claimants, Incapacity benefit, Low Income Scheme, Circulatory Morbidity Index, Standardised Limiting Long Illness ratio and Income Deprivation.

Replacing the ANI with IMD will therefore make little difference.

However, using a different database to determine workload can make a large difference, this was established by the Formula Review Group in 2007 (reference 5 of the article by Boomla et al), calculating income swings up to 40% for some practices.

Applying aggregate area deprivation measures to individual patients, using ANI or IMD, is however not an accurate method to determine the deprivation experienced by individual practices, even if the 'right' database for healthcare use could be agreed on (1).

Beale et al devised a more accurate method to assign deprivation at patient level (2).

Whatever measures and formulae are used, the architects of the current Allocation Formula already indicated it was too volatile to use for determining individual practice funding. (3)

(1) Marra et al. Agreement between aggregate and individual-level measures of income and education: a comparison across three patient groups BMC Health Services Research201111:69
http://www.biomedcentral.com/1472-6963/11/69/abstract

(2) Beale et al. Council tax valuation band of patient residence and clinical contacts in a general practice. BJGP 2005 vol. 55 no. 510 32-36
http://bjgp.org/content/55/510/32

(3) Carr-Hill R, Rice N, Smith P: Towards locally based resource allocation in the NHS. Discussion paper 159. York. 1998, [http://www.york.ac.uk/inst/che/pdf/DP159.pdf]

Competing interests: No competing interests

05 January 2017
Hendrik J Beerstecher
gp
111 Canterbury Road, Sittingbourne, Kent, ME10 4JA
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