Rationale for the new GP deprivation payment scheme in England: effects ofmoving from electoral ward to enumeration district underprivileged area scores

Background: The Department of Health introduced a new deprivation payments system for general practitioners (GPs) on 1 April 1999. Following a three-y ear phasing-in process, registered patients will attract deprivation paymen ts based on the underprivileged area (UPA) score of their enumeration distr ict (ED) of residence, rather than their electoral ward, changing the patte rn and distribution of payments throughout England Aim: To assess the rationale behind the changed deprivation payments system for GPs in England and to examine its impact on GP and practice payments. Design of study: A quantitative study modelling practice-based deprivation payments. Setting A total of 25 450 unrestricted principal GPs in 8919 practices in E ngland. Method The effect of three new components in the system were examined: chan ges in the ED score ranges attracting payment the percentage increase in th e size of successive payment bands and the total budget. The relationship, between consultation rates (used as a proxy for workload) and UPA score was examined, together with changes in GP payments calculated nationally and b y geographical area. Results: A total of 11.6% of the population of England live in wards with a UPA score of 30 or more, qualifying for deprivation payments, and a simila r proportion (11.4%) live in EDs with a UPA score of 20 or more. The larger percentage increases in the size of payments in successive ED UPA bands is supported by the modelled relationship between consultation rate and UPA s core. Financially, under the new deprivations payment system, entitlement w idens with 88% of practices receiving a payment. Overall, 74% of GPs gain a nd 13% lose (3% losing more than pound 1500), with 13% receiving no payment . Conclusion: The new ED system maps onto the previous system well. Moreover it more finely discriminates between smaller areas of different relative de privation and thereby, targets pay ments more accurarely.