Population health needs as predictors of variations in NHS practice payments: a cross-sectional study of English general practices in 2013–2014 and 2014–2015

Abstract

BackgroundNHS general practice payments in England include pay for performance elements and a weighted component designed to compensate for workload, but without measures of specific deprivation or ethnic groups.AimTo determine whether population factors related to health needs predicted variations in NHS payments to individual general practices in England.Design and settingCross-sectional study of all practices in England, in financial years 2013–2014 and 2014–2015.MethodDescriptive statistics, univariable analyses (examining correlations between payment and predictors), and multivariable analyses (undertaking multivariable linear regressions for each year, with logarithms of payments as the dependent variables, and with population, practice, and performance factors as independent variables) were undertaken.ResultsSeveral population variables predicted variations in adjusted total payments, but inconsistently. Higher payments were associated with increases in deprivation, patients of older age, African Caribbean ethnic group, and asthma prevalence. Lower payments were associated with an increase in smoking prevalence. Long-term health conditions, South Asian ethnic group, and diabetes prevalence were not predictive. The adjusted R2 values were 0.359 (2013–2014) and 0.374 (2014–2015). A slightly different set of variables predicted variations in the payment component designed to compensate for workload. Lower payments were associated with increases in deprivation, patients of older age, and diabetes prevalence. Smoking prevalence was not predictive. There was a geographical differential.ConclusionPopulation factors related to health needs were, overall, poor predictors of variations in adjusted total practice payments and in the payment component designed to compensate for workload. Revising the weighting formula and extending weighting to other payment components might better support practices to address these needs.

Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis

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Impact of primary care funding on secondary care utilisation and patient outcomes: a retrospective cross-sectional study of English general practice

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Exploring the needs of people with dementia living at home reported by people with dementia and informal caregivers: a systematic review and Meta-analysis

“…It has produced 48 prevalence estimates that reflect the pooled burden of need experienced by the dementia populations of six research studies conducted in The Netherlands, UK, Poland, Ireland, Germany, Norway, Portugal, Italy and Sweden. These outcomes are of interest as needs can lead to someone being put at risk of adverse outcomes including increased multi-morbidity (Levene et al, 2017;Seden, 2016). Therefore, greater understanding of these needs and the priority placed upon them by people with dementia and their informal caregivers, can inform the design of services to ensure they are person-centred, rather than disease focused.…”