More equitable systems for allocating general practice deprivation payments: financial consequences.

摘要

BACKGROUND: The allocation of general practitioner (GP) deprivation payments has been a controversial topic since they were first proposed. It has recently been suggested that the current system could be made more equitable if the payments were allocated at enumeration districts and if there was a more graded relationship between Jarman score and funding. However, the implications of these changes on the distribution of deprivation payments have not been worked out. AIM: To explore the resource implications of the proposed changes to the methods of allocating GP deprivation payments within Northern Ireland, one of the few places in the United Kingdom (UK) where this can be done. METHOD: Three alternatives to the present system, incorporating the proposed changes, were modelled. The reallocation of deprivation payments between areas was determined. RESULTS: The proportion of population attracting GP deprivation payments depends on the scheme chosen. A system that entails a lower threshold Jarman score and more payment bands will bring between two and three times more areas and people within the scheme. Each of the three alternatives would redirect funds away from areas within the current payment bands towards those that previously failed to attract any deprivation payments. The loss would be greatest for those areas within the present 'low' payment band and least for those in the 'high' payment band. CONCLUSIONS: More equitable alternatives for allocating GP deprivation payments are feasible, although they will lead to significant movements of funds between areas. This may necessitate the introduction of further transitional payments.