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Rural primary care underfunding
Dispensing cross subsidy a reality
Dr Allan Tennant reports
12th of August 2009
In June DDA Online reported on the dispensing doctor debate which took place in the Scottish parliament.
Subsequently I wrote an article suggesting that whichever part of the UK you live in, what happens in another home country can affect you. It is important that you keep abreast of all UK developments, otherwise news and information will pass you by.
We have received emails from members who told us that we had not reported the minister's comments made during the debate, regarding cross subsidy of medical services by dispensing.
Shona Robinson said, "The extra remuneration that GP practices receive for providing dispensing services is intended only to cover the additional cost of providing those services; it was never intended to cross-subsidise their base general medical services provision. However, I recognise what has been said in the debate about the realities of the situation in some areas of the country."
I can assure members that DDA Online reported these comments within hours of them being uttered.
Dr David Baker , DDA CEO said, "We agree with the minister that the additional remuneration received by dispensing doctors is to cover the delivery of the service, but the bald figures show that dispensing income does subsidise medical services; it shouldn't have to but it does. If dispensing were to cease, many rural practices would have questionable viability and rural patients would be much worse off."
Dr Richard West added, " The cross subsidy occurs across the whole of the UK not just Scotland and this was reflected in the survey that we published last year."
The Commision for Rural communities published a report, Darzi Analysis Access to and quality of, healthcare in rural England in February 2008, which showed the lower levels of health funding in rural areas.
This document suggests that there is a mismatch between demand and funding because urban deprivation is considered to be the measure of need.
As you move from major urban to the most rural areas, life expectancy rises, and deaths from cancers and circulation disease fall. This information results in government views that less healthcare is needed in rural than urban areas; whilst at the same time it is believed that rural patients are better at accessing healthcare.
This affects funding for NHS resources; on average, the most rural PCTs received in 2007-08 only 84% of the per capita allocation received by ‘Major Urban' PCTs.
The report questions the legitimacy of these assertions and, where appropriate, the analyses which underpin them and goes onto say "There is a real danger that the provision of health services in rural areas, aspects of which are already demonstrably stressed, will be further undermined if the presumption that rural populations gain disproportionate benefits from the NHS goes unchallenged."
The report has excellent proofs and points to show that funding follows deprivation rather than age related needs. So that younger urban populations with poverty get more funding than rural areas with more older people who tend to be the users of the health service. The report says, "A key consequence of this mismatch between needs and resources has been that PCTs serving rural populations have tended to experience the greatest difficulties balancing their budgets"
The report has a section on "Is access to primary care "worse in areas of greater need?"
The CRC shows that although urban GPs have 12% more patients per doctor than rural GPs, the latter serves 6% more people with CHD and 23% more people with cancer. It also shows that much larger distances patients and doctors need to travel to and from the surgery.
The report concludes, " whilst GPs in major urban PCTs serve more ‘weighted' patients (due to levels of deprivation), when the provision of GPs is measured in terms of the burden of ill health, rural GPs each serve more patients than their urban counterparts." And "rural areas generally tend to receive lower than average per capita funding even though they have higher than average absolute healthcare needs."
The reality is that rural healthcare in the UK is underfunded and this is partly balanced in primary care by the cross subsidy from doctor dispensing.