GP funding is 'robbing the poor to pay for the rich'

GPs in deprived areas are not getting the funding they need to tackle health inequalities, BBC Scotland has learned.

Research suggests the funding formula which is supposed to increase GPs' resources in poorest areas is still weighted in favour of the richest.

Researchers found the average spend per patient per year was £7 higher in the top 10% of affluent areas compared with the bottom 10% of deprived areas.

The Scottish government said spending on GP services had increased by 13%.

"This formula has robbed the poorest and sickest people in Scotland to pay for GP care in affluent areas," said Drumchapel GP, Dr Peter Cawston.

"It is far worse than we even thought - patients who live in poorer areas are allocated less money than patients in wealthy areas."

The study was carried out by researchers at Glasgow and Dundee universities and covered nearly every practice in Scotland.

It found that the average spend per patient per year was £127 in the top 10% of affluent areas compared with £120 in the bottom 10% of deprived areas.

"That doesn't sound very much," said Dr Cawston, "but with that £7 we could have offered 2,000 extra GP appointments a year in my GP practice alone. These are appointments people desperately need."

On average, people living in deprived areas of Scotland die more than 10 years earlier than people in affluent areas and become ill in their 50s rather than their 70s.

"I think these figures are shocking," said Prof Graham Watt, of Glasgow University's Institute of Health and Wellbeing.

"It's a question of fairness. For a government that flies the flag of fairness and social justice, this is a real test of what their understanding and commitment to that is."

He said: "The challenge in a period of austerity is whether social justice and fairness are things that we can only afford in good times or whether we apply them in bad times.

"It's not because there isn't the best of intentions or the best methods or the best statisticians. The data which is available is insufficient to deal with this problem."

Health Secretary Shona Robison said: "Under this government spending on GP services has increased by £88.7m or nearly 13%.

"In June, we also announced an additional £60m for GP and primary care services, through our Primary Care Transformation Fund, which is being allocated to projects to reduce GP workload and encourage innovation in primary care."

She said the fund would help GPs across the country - including those practices in deprived areas.

"When allocating funding for GPs, we take into account the additional needs of patients in deprived areas and provide extra funding to those practices located there," Ms Robison said.

"GP funding is weighted to reflect factors such as deprivation - as we know that this generally means their patients have more complex conditions resulting in an increased workload for the GP."

However, the researchers pointed out that finding the right funding system was complicated.

While practices in deprived areas have higher numbers of younger patients with multiple conditions, practices in more affluent areas have higher numbers of frail, older patients.

Ms Robison added: "We are sympathetic to the case that we need to do more to ensure GPs work in disadvantaged communities is backed up by the right levels of investment.

"GP contractual arrangements now place much more emphasis on patient care being provided by the whole clinical team, including nurses and pharmacists, and therefore the concept of average numbers of patients per GP is now less meaningful.

"This review will inform the development of a brand new Scottish GP contract from 2017, where we will seek to ensure that both GPs and patients get a fair deal. The impact of deprivation will be a part of this important work."