Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK Quality and Outcomes Framework.
OBJECTIVE
To examine whether the quality of primary care measured by the 2004 contract varies with socioeconomic deprivation.


METHODS
Retrospective analysis of publicly available data, comparing quality indicators used for payment that allow exclusion of patients (payment quality) and indicators based on the care delivered to all patients (delivered quality).


METHODS
1024 general practices in Scotland.


METHODS
Regression coefficients summarising the relationships between deprivation and payment and delivered quality.


RESULTS
Little systematic association is found between payment quality and deprivation but, for 17 of the 33 indicators examined, delivered quality falls with increasing deprivation. Absolute differences in delivered quality are small for most simpler process measures, such as recording of smoking status or blood pressure. Greater inequalities are seen for more complex process measures such as diagnostic procedures, some intermediate outcome measures such as glycaemic control in diabetes and measures of treatment such as influenza immunisation.


CONCLUSIONS
The exclusions system succeeds in not penalising practices financially for the characteristics of the population they serve, but does not reward the additional work required in deprived areas and contributes to a continuation of the inverse care law. The contract data collected prevent examination of most complex process or treatment measures and this analysis is likely to underestimate the extent of continuing inequalities in care. Broader lessons cannot be drawn on the effect on inequalities of this new set of incentives until changes are made to the way contract data are collected and analysed.
McLean
G
G
General Practice and Primary Care, Community Based Sciences, University of Glasgow, Glasgow, UK. gml17y@clinmed.gla.ac.uk
Sutton
M
M
Guthrie
B
B
D019317:Evidence-Based Medicine; D006801:Humans; D011203:Poverty; D011320:Primary Health Care / Q000592:standards*; D015980:Public Health Practice / Q000592:standards; D011640:Public Policy; D011786:Quality Control; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom