Funding a primary care LED NHS: Achieving a model for more equitable allocation of healthcare resources at a sub-district level

Abstract

Background: Current resource allocation for health services have developed in a haphazard and inequitable way. This project aimed to determine a fairer and more rational way to distribute health authority's (HA's) money to general practitioners (GPs). Methods: A dataset was developed to examine the way resources were spent on patients at the level of general practice. Important managerial aspects of the project were addressed. This involved the establishment of the ‘Equity Group’ of GPs to work with the HA. The group sought a measure of health need that was rigorous and scientifically based but was also practical and politically acceptable to GPs and the HA. The York Relative Needs Index (RNI) was chosen, and applied to populations at practice level. An implementation plan was then developed by the Equity Group. Results: Results demonstrated considerable inequalities between practices in age-adjusted use of healthcare resources. There was low correlation between the level of need in practices and the per capita expenditure. Applying the York RNI to practice populations indicated current practice allocations were within the range 82–126 per cent of their needs-based target. The managerial implications of the proposed changes are described. Conclusions: The new methods for resource allocation appear to be an advance on the unplanned methods which have evolved. Full evaluation of the long-term results of redistributing health resources will be needed. Important aspects of this project were the participation of GPs and general development of the concept of equity in North Derbyshire. © 1997, Oxford University Press.