NHS 'underfunding' poorest areas

Analysis of budgets allocated to GPs to pay for drugs and hospital care for their patients suggested that the wealthiest tenth are overfunded by an average of more than 2% and the poorest underfunded by a similar proportion.

On average, practices in poorer areas lost out and those in wealthier neighbourhoods gained to the tune of £94,000 annually - the equivalent of 12 coronary bypasses. Only a handful of primary care trusts (PCTs) were passing on funds in line with the Department of Health's "fair shares" guidelines for equitable distribution, according to figures released to the Health Service Journal under freedom of information legislation.

Some 59 PCTs provided the magazine with details of 3,148 GP practice based commissioning budgets covering more than one-third of the practices in England, most of them relating to 2008/09. The figures ranged from a practice in Brent, north London, which was receiving 55% below its fair shares entitlement, to one in west Berkshire which was overfunded by 39%.

In 40 out of the 59 PCTs which responded there was evidence that those in poorer areas got less than their fair share while those in richer areas got more.

PCTs with the strongest tendency to underfund practices in poor areas, according to the HSJ analysis, were Trafford, Oxfordshire, Warwickshire, Harrow, North Lancashire, Bolton, Kirklees, Hastings & Rother, Central & Eastern Cheshire and East Riding of Yorkshire. In Trafford, the GP practice in the richest area was overfunded by 13% while the poorest was underfunded by 21%.

Only six of the PCTs - Darlington, Halton & St Helens, Hertfordshire, Hillingdon, Oldham and Wiltshire - distributed funds exactly according to the fair shares formula.

David Pink, chief executive of patient representative body National Voices, told the magazine: "We can't have an NHS funding system that favours areas of the healthy and wealthy at the expense of areas of deprivation and chronic illness."

A Department of Health spokesman told the HSJ: "Department of Health guidance requires PCTs to ensure practices move towards fair share budgets, and seeks to bring about change to those furthest away from their fair share budgets. Practice based commissioning budget setting is based on PCT discretion."

Liberal Democrat health spokesman Norman Lamb said: "The Government should be providing incentives such as a Patient Premium for GPs to work in disadvantaged communities, and not the other way round."