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Research

Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis

Jessica A Lee, Rachel Meacock, Evangelos Kontopantelis, James Matheson and Matthew Gittins
British Journal of General Practice 2019; 69 (688): e794-e800. DOI: https://doi.org/10.3399/bjgp19X705545
Jessica A Lee
School of Medical Sciences;
Roles: Medical student
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Rachel Meacock
Division of Informatics, Imaging and Data Sciences;
Roles: Senior lecturer in health economics
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Evangelos Kontopantelis
Division of Informatics, Imaging and Data Sciences;
Roles: Professor of data science and health services research
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James Matheson
Hill Top Surgery, Hope Citadel Healthcare, Shared Health Foundation, Oldham.
Roles: GP
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Matthew Gittins
Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester.
Roles: Lecturer in biostatistics
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    Figure 1.

    Frequency of Greater Manchester practices per national deprivation (IMD) quintile. IMD = Index of Multiple Deprivation.

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  • 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.
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    Table 1.

    Descriptive statistics per practice of outcomes and primary confounders split by IMD social deprivation quintiles

    Number of practicesVariableDeprivation quintileTotal or average n= 472
    5 (most deprived) n= 2454 n= 1013 n= 582 n= 391 (least deprived) n= 29
    List sizeMean (SD)5738 (3141)6838 (4187)7155 (3983)7444 (4089)6839 (4258)6356 (3691)
    Range1125–21 7121577–29 6141772–16 7601892–16 7281638–20 3201125–29 614
    Practice ruralityFrequency urban (%)245 (100)101 (100)58 (100)35 (90)29 (100)468 (99)
    Contract typeAPMS 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)
    Range116 916– 3 747 783203 087– 3 291 125230 638– 2 496 808273 010– 1 887 854201 872– 2 385 852116 915– 3 747 783
    Average payment per registered patient,a £Mean (SD)159 (95)142 (27)136 (16)141 (30)142 (65)150 (73)
    Range103–115589–247101–179107–272104–47489–1155
    Average payment per weighted patient,b £Mean (SD)147 (74)136 (26)131 (13)141 (30)147 (64)142 (58)
    Range93–76382–259103–175107–250114–47382–763
    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)
    Range0–10–30–20–20–10–3
    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)
    Range1–5031–2002–342–260–250–503
    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)
    Range2–1573–214–187–167–162–157
    QOF achievement, %cMean (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)
    Range52.95–100.0085.69–100.0069.67–100.0087.06–100.0089.28–100.0052.95–100.00
    Exceptioning rate (clinical domain)cMean (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)
    Range0.00–21.363.01–21.263.05–17.242.88–24.342.49–13.270.00–24.34
    Number of practicesn= 220n= 99n= 54n= 38n= 25n= 436
    CQC ratingsOutstanding (%)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.

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    Table 2.

    Estimated regression associations between primary care payments and practice area deprivation quintile

    Dependent variableUnstandardised coefficient, B95% 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 PMS5.871−8.088 to 19.829
    Contract type APMS162.395138.823 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 15.499−12.808 to 23.807
    Contract type PMS8.893−1.858 to 19.644
    Contract type APMS140.780122.777 to 158.784
    NES payments per registered patient
    Quintile 40.0720.013 to 0.131
    Quintile 30.069−0.003 to 0.142
    Quintile 20.1970.108 to 0.287
    (least deprived) Quintile 10.032−0.066 to 0.130
    Practice rurality−0.264−0.526 to −0.002
    Contract type PMS0.0650.008 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 APMS24.40213.110 to 35.694
    QOF payments per registered patient
    Quintile 4−0.026−1.724 to 1.673
    Quintile 30.518−1.574 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 PMS0.187−1.470 to 1.845
    Contract type APMS3.1450.372 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.

    • View popup
    Table 3.

    Estimated regression associations between QOF ratings and practice area deprivation quintile

    Dependent variableUnstandardised coefficient, B95% CI
    Total percentage QOF achievement (clinical domain)
    Quintile 41.9900.678 to 3.303
    Quintile 31.167−0.450 to 2.785
    Quintile 22.1550.164 to 4.145
    (least deprived) Quintile 12.052−0.118 to 4.222
    List size per 100 patients0.0250.011 to 0.040
    Practice rurality1.325−4.464 to 7.115
    Contract type PMS0.409−0.869 to 1.687
    Contract type APMS1.693−0.467 to 3.852
    Exception rate (clinical domain)
    Quintile 40.430−0.439 to 1.300
    Quintile 3−1.003−2.075 to 0.068
    Quintile 20.689−0.630 to 2.008
    (least deprived) Quintile 1−1.712−3.150 to −0.274
    List size per 100 patients0.0220.012 to 0.031
    Practice rurality0.044−3.792 to 3.880
    Contract type PMS−0.604−1.450 to 0.243
    Contract type APMS2.9121.481 to 4.343
    • CI = confidence interval. QOF = Quality and Outcomes Framework.

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British Journal of General Practice: 69 (688)
British Journal of General Practice
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November 2019
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Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis
Jessica A Lee, Rachel Meacock, Evangelos Kontopantelis, James Matheson, Matthew Gittins
British Journal of General Practice 2019; 69 (688): e794-e800. DOI: 10.3399/bjgp19X705545

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Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis
Jessica A Lee, Rachel Meacock, Evangelos Kontopantelis, James Matheson, Matthew Gittins
British Journal of General Practice 2019; 69 (688): e794-e800. DOI: 10.3399/bjgp19X705545
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Keywords

  • deprivation
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