TIM DORAN UNIVERSITY OF YORK

1. EQUITY IN PRIMARY CARE PAYING FOR PERFORMANCE • TIM DORAN • UNIVERSITY OF YORK

2. HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

3. HEALTH INEQUALITIES IN ENGLAND PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORLING ET AL, GRIM REAPER’S ROAD MAP, BRISTOL 2008

4. HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

5. 1948: THE NATIONAL HEALTH SERVICE PRIMARY CARE AND HEALTH DISPARITY BEVERIDGE AND THE FIVE GIANTS

6. “…at best… very unsatisfactory and at worst a positive source of public danger.” PRIMARY CARE UNDER THE NHS “Conditions are… bad enough to turn a good doctor into a bad one within a very short time.” PRIMARY CARE AND HEALTH DISPARITY SOURCE: COLLINGS, LANCET 1950; 6625: 555-585.

7. GLYNCORRWG POPULATION 1900 64% UNSKILLED HEALTH CENTRE ‘SCREENING’ FOR BP, SMOKING, CHOLESTEROL, DIABETES, LUNG FUNCTION, BMI, ALCOHOLISM MORTALITY SMR 94 (-6%) (BLAENGWYNFI 16O) REPEALING THE INVERSE CARE LAW PRIMARY CARE AND HEALTH DISPARITY SOURCE: TUDOR HART ET AL, BMJ 1991; 302: 1509-1503.

8. HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

9. INTRODUCED 2004 (ALL UK GENERAL PRACTICES) • 146 QUALITY INDICATORS COVERING: • MANAGEMENT OF CHRONIC CONDITIONS • ORGANISATION OF CARE • PATIENT EXPERIENCE • INDICATORS WORTH 0.5-57 POINTS (TOTAL 1,000) • 1 POINT = £125 (€145) • PRACTICES EXCLUDE INAPPROPRIATE PATIENTS • ACHIEVEMENT SCORES PUBLICLY REPORTED QUALITY & OUTCOMES FRAMEWORK PRIMARY CARE AND HEALTH DISPARITY OVERVIEW OF THE QUALITY & OUTCOMES FRAMEWORK

10. POINTS: 0-19 PAYMENT: £0-1,444 E.G.: CONTROL OF BLOOD PRESSURE LOWERTHRESHOLD UPPER THRESHOLD PERCENTAGE ACHIEVEMENT PRIMARY CARE AND HEALTH DISPARITY CHD6: PERCENTAGE OF CHD PATIENTS WITH BP ≤150/90 MMHG

11. REPORTED ACHIEVEMENT IMPACT ON INEQUALITIES 2004/5 2005/6 2006/7 PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORAN ET AL. LANCET 2008; 372: 728-736.

12. PROCESSES OUTCOMES IMPACT ON INEQUALITIES ACHIEVEMENT DEPRIVATION QUINTILE PRIMARY CARE AND HEALTH DISPARITY DIABETES INDICATORS, BY DEPRIVATION QUINTILE

13. ACHIEVEMENT ABOVE PREDICTED NON-INCENTIVIZED ACTIVITIES NO EFFECT 2004/5 2006/7 PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORAN ET AL. BMJ 2011; 342: D3590.

14. RELATIVE GAIN SYSTEM ADVANTAGES COMPUTING SYSTEM PRIMARY CARE AND HEALTH DISPARITY ADDITIONAL REMUNERATION COMPARED WITH SYSTEM ‘G’

15. VIEWS OF PRACTITIONERS PRIMARY CARE AND HEALTH DISPARITY SOURCE: WEHRLI U, FUR ELISE

16. “It's a good idea – I think it makes things tangible and quantifies things…” “…although I hate it. I do.” PRIMARY CARE AND HEALTH DISPARITY SOURCE: MCDONALD ET AL. BMJ 2007; 334: 1357-1362.

17. QUESTIONS?PAYING FOR PERFORMANCE TIM.DORAN@YORK.AC.UK

18. PATIENTS PER PHYSICIAN EQUITABLE CARE PROVISION? DEPRIVATION ‘DECILE’ PRIMARY CARE AND HEALTH DISPARITY DISTRIBUTION OF PRIMARY CARE PHYSICIANS (1996)