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Equity is the foundation stone of the NHS and by international comparisons it is indeed one of the fairest health systems in the world. But how far have we managed to ensure that the resources available are indeed matched to need? The major determinants of health inequality are mostly issues that the are beyond the scope of any health service to address. However, one often overlooked part of the Health and Social Care Act 2012 was the introduction of legal duties on NHS England and CCGs to to ensure that all the decisions they make are scrutinised through the lens of health inequalities.
As things stand those living in areas where the Index of Multiple Deprivation score is in the bottom quintile enjoy 12 years more of good health than those from the most deprived quintile. The impact of this on General Practice is that someone aged 50 in the poorest areas will consult at the same rate as a 70 year old from the most affluent areas. The situation is no doubt exacerbated by the fact that many deprived areas can not recruit from the dwindling GP workforce to meet the need for these extra consultations.
The prior attempt in 2007 to review the Carr-Hill formula that determines the core funding of primary care would have shifted significant resources to areas of deprivation. The majority (75%) of Primary Care Organisations accepted the proposal but only 29% of GPs accepted the recommendations of the Formula Review Group. Clearly without extra resources there were going to be more losers than winners.
With the vast majority of patient contacts occurring in primary care, the only way that the NHS will actually deliver care based on need and make its contribution to reducing health inequalities is to put more value on the work that is done in General Practice, tear up the iniquitous funding formula, and slay the sacred cow that is GPs' independent contractor status.