Shortfalls of funding for general practice in deprived areas

INTRODUCTION

In April 2019 the Haxby Group, through a contract tender process, acquired two surgeries in a deprived area of Hull, Yorkshire. These are specifically located in Calvert and Newington with approximately 10 000 patients. This, in addition to six sites in York and three other sites in Hull, with centralised administrative services, make up the Haxby Group. The transformative process that has followed has highlighted many positive outcomes from the use of at-scale general practice and diversifying the workforce but has become increasingly hindered by funding deficits. In particular the use of the Carr-Hill formula and Quality and Outcomes Framework (QOF)-driven payments negatively impact a practice’s ability to provide appropriate care in deprived populations.

The population served by this new contract is predominantly young (Figure 1). The area, like most of Hull, is especially high on the Index of Multiple Deprivation, scoring 43.7, compared with 28.1 at another Haxby practice in Hull and 10.4 in York. As is often seen in deprived areas, there is a high incidence of drug and alcohol misuse plus mental health problems. Alongside this, 9.0% of the patients are recorded with obesity and 55.9% as smokers. However, given the average age of the population, most chronic diseases have a prevalence below the clinical commissioning group (CCG) and national averages (Table 1).