Editorials

Deprivation payments revisited (again)

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7058.641 (Published 14 September 1996) Cite this as: BMJ 1996;313:641
  1. Richard Hobbs, Professor,
  2. Tim Cole, Senior scientist
  1. Department of General Practice, Medical School, Birmingham B15 2TT
  2. MRC Dunn Nutrition Centre, Cambridge CB4 1XJ

    Equity remains a problem with current method of allocation

    With the rising workload in general practice and an emerging manpower crisis, destabilising influences such as unpredictable shifts in income are to be avoided. Unfortunately, continuing to allocate deprivation payments to practices on the basis of geographical wards has resulted in large shifts in resources. This is because data from the 1991 census have now replaced the 1981 data, which had been used to calculate deprivation payments since the introduction of the new general practitioner contract in 1990.1 The short report in this week's BMJ by Majeed et al (p 669) models the effects of applying census data to the existing rigid formula for allocating deprivation awards. Small shifts in the Jarman deprivation score around the payment bands can translate to practices gaining or losing tens of thousands of pounds, with no discernible change in their clinical workloads: one practice reported a 15% shift in income after a change in a ward boundary.2 Such a lottery of winners and losers has been predicted since the introduction of deprivation payments,3 4 5 and it is depressing that nothing has …

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