Primary care networks and health inequality: a policy analysis

The Problem

Health inequality is worsening within the UK resulting in reduced life expectancy in low-socioeconomic groups. Good primary care is internationally recognised as a fundamental component of health equality. Primary care in the UK is being altered through the introduction of primary care networks (PCNs), whereby geographically contiguous GP practices are funded to contractually align.  Therefore, it is important to understand how PCNs will influence health inequality, which I assess here.

Your Approach

An analysis of the GP contract agreement, it’s update and surrounding documentation was performed. Initially a literature review was undertaken followed by an assessment of the contents, outcomes and trade-offs of the policy, utilising adapted principles from Bardach’s eightfold path for policy analysis. The focus of this analysis was an assessment of the funding formula, additional roles reimbursement scheme (ARRS) and service specifications to evaluate the probable interaction with health inequality.

The Learning

There is government intent to increase primary care funding through PCNs, however there are underlying flaws. Aspects of the funding mechanism lack inequality weighting and when it is applied, the flawed Carr-Hill formula is used. PCNs control the distribution of funding within the network, which may not be according to deprivation. Much of the funding is through the ARRS, which introduces new healthcare professionals into primary care. These have minimal evidence supporting their implementation, which is similar to concerns regarding the clinical director. The service specifications are broad but some focus on disadvantaged groups, such as the learning disabled, indicates potential inequality improvements.

Why it Matters

Addressing health inequality is vital to improve population health, therefore understanding and improving the policies we work within is essential. This analysis identified key areas to focus upon during my pre-doctoral study of PCNs. This will help refine their implementation to most effectively address health inequality.

Presenting Author: Hutchinson, J. – Academic Clinical Fellow, Centre for Primary Care, University of Manchester. Jjhutchinson93@gmail.com