Article Figures & Data
Figures
- Figure 1.
Frequency of Greater Manchester practices per national deprivation (IMD) quintile. IMD = Index of Multiple Deprivation.
Tables
How this fits in
There has been no previous work looking at primary care funding or quality in the context of the devolution of the health and social care budget to Greater Manchester. Styled ‘DevoManc’, the devolution was promoted as a way to increase local autonomy and reduce the large health inequities in Greater Manchester. This work details how local control over primary care financing in Greater Manchester following devolution is limited, and primary care practices in highly deprived areas are not receiving additional funding, despite well described greater need. - Table 1.
Descriptive statistics per practice of outcomes and primary confounders split by IMD social deprivation quintiles
Number of practices Variable Deprivation quintile Total or average n= 472 5 (most deprived) n= 245 4 n= 101 3 n= 58 2 n= 39 1 (least deprived) n= 29 List size Mean (SD) 5738 (3141) 6838 (4187) 7155 (3983) 7444 (4089) 6839 (4258) 6356 (3691) Range 1125–21 712 1577–29 614 1772–16 760 1892–16 728 1638–20 320 1125–29 614 Practice rurality Frequency urban (%) 245 (100) 101 (100) 58 (100) 35 (90) 29 (100) 468 (99) Contract type APMS frequency (%) 21 (8.6) 4 (4) 0 (0) 3 (7.7) 1 (3.4) 29 (6.1) GMS frequency (%) 185 (75.5) 68 (67.3) 50 (86.2) 25 (64.1) 17 (58.6) 345 (73.1) PMS frequency (%) 39 (15.9) 29 (28.7) 8 (13.8) 11 (28.2) 11 (37.9) 98 (20.8) Total payments, £ Mean (SD) 803 867 (486 204) 866 973 (497 923) 846 883 (504 127) 923 717 (494 201) 854 000 (523 521) 840 056 (493 467) Range 116 916– 3 747 783 203 087– 3 291 125 230 638– 2 496 808 273 010– 1 887 854 201 872– 2 385 852 116 915– 3 747 783 Average payment per registered patient,a £ Mean (SD) 159 (95) 142 (27) 136 (16) 141 (30) 142 (65) 150 (73) Range 103–1155 89–247 101–179 107–272 104–474 89–1155 Average payment per weighted patient,b £ Mean (SD) 147 (74) 136 (26) 131 (13) 141 (30) 147 (64) 142 (58) Range 93–763 82–259 103–175 107–250 114–473 82–763 National Enhanced Service payments per registered patient, £ Mean (SD) 0.09 (0.122) 0.17 (0.354) 0.16 (0.275) 0.32 (0.479) 0.14 (0.183) 0.14 (0.26) Range 0–1 0–3 0–2 0–2 0–1 0–3 Local Enhanced Service payments per registered patient, £ Mean (SD) 18.73 (37.35) 17.49 (28.89) 13.79 (8.44) 12.27 (5.97) 9.53 (6.90) 16.76 (29.98) Range 1–503 1–200 2–34 2–26 0–25 0–503 QOF payments per registered patient, £ Mean (SD) 12.17 (9.75) 12.02 (2.74) 12.41 (2.58) 12.25 (1.99) 11.69 (1.98) 12.14 (7.23) Range 2–157 3–21 4–18 7–16 7–16 2–157 QOF achievement, %c Mean (SD) 95.05 (6.64) 97.29 (3.19) 96.43 (6.37) 97.54 (3.29) 97.39 (3.18) 96.05 (5.71) Range 52.95–100.00 85.69–100.00 69.67–100.00 87.06–100.00 89.28–100.00 52.95–100.00 Exceptioning rate (clinical domain)c Mean (SD) 8.61 (3.99) 9.07 (3.74) 7.68 (3.18) 9.56 (4.20) 6.85 (2.89) 8.56 (3.84) Range 0.00–21.36 3.01–21.26 3.05–17.24 2.88–24.34 2.49–13.27 0.00–24.34 Number of practices n= 220 n= 99 n= 54 n= 38 n= 25 n= 436 CQC ratings Outstanding (%) 9 (4.1) 9 (9.1) 1 (1.9) 1 (2.6) 1 (4) 21 (4.8) Good (%) 199 (90.5) 86 (86.9) 52 (96.3) 37 (97.4) 24 (96) 398 (91.3) Requires improvement (%) 5 (2.3) 4 (4.0) 1 (1.9) 0 (0) 0 (0) 10 (2.3) Inadequate (%) 7 (3.2) 0 (0) 0 (0) 0 (0) 0 (0) 7 (1.6) ↵a Registered patients is the number of patients registered at each practice at the end of the financial year.
↵b Weighted patients is the number of patients per practice as calculated by the global sum formula to estimate patient workload. Average payments per patient describe the total payments figure (before deductions), divided by either the number of registered or weighted patients.
↵c Data from QOF dataset, not NHS payments dataset. APMS = Alternative Provider Medical Services. CQC = Care Quality Commission. GMS = General Medical Services. IMD = Index of Multiple Deprivation. PMS = Personal Medical Services. QOF = Quality and Outcomes Framework.
- Table 2.
Estimated regression associations between primary care payments and practice area deprivation quintile
Dependent variable Unstandardised coefficient, B 95% CI Average payments per registered patient Quintile 4 −7.073 −22.517 to 8.371 Quintile 3 −5.234 −24.756 to 14.289 Quintile 2 −14.234 −32.379 to 3.912 (least deprived) Quintile 1 −10.483 −34.310 to 13.344 Contract type PMS 5.871 −8.088 to 19.829 Contract type APMS 162.395 138.823 to 185.967 Average payments per weighted patient Quintile 4 −5.352 −16.382 to 5.679 Quintile 3 −3.105 −16.691 to 10.481 Quintile 2 −5.209 −21.193 to 10.775 (least deprived) Quintile 1 5.499 −12.808 to 23.807 Contract type PMS 8.893 −1.858 to 19.644 Contract type APMS 140.780 122.777 to 158.784 NES payments per registered patient Quintile 4 0.072 0.013 to 0.131 Quintile 3 0.069 −0.003 to 0.142 Quintile 2 0.197 0.108 to 0.287 (least deprived) Quintile 1 0.032 −0.066 to 0.130 Practice rurality −0.264 −0.526 to −0.002 Contract type PMS 0.065 0.008 to 0.123 Contract type APMS −0.026 −0.123 to 0.070 LES payments per registered patient Quintile 4 −0.085 −7.001 to 6.832 Quintile 3 −2.856 −11.375 to 5.663 Quintile 2 −6.947 −17.437 to 3.544 (least deprived) Quintile 1 −7.895 −19.375 to 3.584 Practice rurality −7.143 −37.774 to 23.489 Contract type PMS −0.267 −7.017 to 6.482 Contract type APMS 24.402 13.110 to 35.694 QOF payments per registered patient Quintile 4 −0.026 −1.724 to 1.673 Quintile 3 0.518 −1.574 to 2.609 Quintile 2 −0.161 −2.737 to 2.415 (least deprived) Quintile 1 −0.354 −3.173 to 2.465 Practice rurality −2.447 −9.969 to 5.074 Contract type PMS 0.187 −1.470 to 1.845 Contract type APMS 3.145 0.372 to 5.918 APMS = Alternative Provider Medical Services. CI = confidence interval. LES = Local Enhanced Service. NES = National Enhanced Service. PMS = Personal Medical Services. QOF = Quality and Outcomes Framework.
- Table 3.
Estimated regression associations between QOF ratings and practice area deprivation quintile
Dependent variable Unstandardised coefficient, B 95% CI Total percentage QOF achievement (clinical domain) Quintile 4 1.990 0.678 to 3.303 Quintile 3 1.167 −0.450 to 2.785 Quintile 2 2.155 0.164 to 4.145 (least deprived) Quintile 1 2.052 −0.118 to 4.222 List size per 100 patients 0.025 0.011 to 0.040 Practice rurality 1.325 −4.464 to 7.115 Contract type PMS 0.409 −0.869 to 1.687 Contract type APMS 1.693 −0.467 to 3.852 Exception rate (clinical domain) Quintile 4 0.430 −0.439 to 1.300 Quintile 3 −1.003 −2.075 to 0.068 Quintile 2 0.689 −0.630 to 2.008 (least deprived) Quintile 1 −1.712 −3.150 to −0.274 List size per 100 patients 0.022 0.012 to 0.031 Practice rurality 0.044 −3.792 to 3.880 Contract type PMS −0.604 −1.450 to 0.243 Contract type APMS 2.912 1.481 to 4.343 CI = confidence interval. QOF = Quality and Outcomes Framework.
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