TY - JOUR T1 - Primary care funding entrenches health inequalities: time for a rethink JF - British Journal of General Practice JO - Br J Gen Pract SP - 102 LP - 104 DO - 10.3399/bjgp21X714965 VL - 71 IS - 704 AU - Mark Ashworth AU - Veline L’Esperance AU - Thomas Round Y1 - 2021/03/01 UR - http://bjgp.org/content/71/704/102.abstract N2 - Fifty years since the term was first used to describe the mismatch between healthcare provision and healthcare need,1 the inverse care law is alive and well. Coined by Julian Tudor Hart, a GP in a coal-mining community in south Wales, the term was a clever pun on the inverse square law. And it has stuck ever since.Although primary care in 2021 has changed beyond recognition since 1971, one factor remains largely unchanged and it is a factor that perpetuates disparity. The funding of primary care is still largely based on capitation payments together with the more recent addition of target-based pay-for-performance rewards.Equality of practice funding in areas of high and low social deprivation, so-called ‘flat funding’, simply widens healthcare inequality in the presence of unequal healthcare needs.2 Marmot has advocated the principle of ‘proportionate universalism’, whereby universal healthcare provision is supplemented by targeted approaches related to the level of social need.3 But surely current primary care funding already invests in deprived communities?Capitation funding, accounting for the majority of funding, is not linked with social deprivation, although it is linked to measures of community ill health.4 The Carr-Hill … ER -