Deprivation scores and NHS practice payment trends in England 2018-2019 to 2023-2024:a multivariable analysis

Funding shortfalls persist for practices in the most deprived areas, despite capitation formula adjustments.

To evaluate whether deprivation scores predicted practice payment trends between 2019 and 2024.

Multivariable analysis was undertaken of English general practices (2018-2019 to 2023-2024), excluding practices with <750 patients or average payments >£500 per patient per year, using published data.

A quadratic mixed-effects model was fitted, using cluster-robust standard errors. The outcome was log-transformed average NHS practice payments per patient (net of deductions/reimbursements). The fixed effects were time (categorical), the Index of Multiple Deprivation (IMD) score (higher score indicates greater deprivation), and seven covariates (geographical, population, or organisational). The random effect was practices' random intercepts.

Among 5726 included practices, median payments increased in nominal terms (8.6%) but decreased in real terms (-12.6% consumer price index [CPI] and -9.0% CPI for health). The IMD-payment trend relationship was curvilinear, peaking at IMD 49.8 (1.4% above mean deprivation, IMD 23.2), declining to 0.6% higher at IMD 70.0. More positive payment trends were associated with non-London regions, rurality, greater long-term conditions (LTCs) prevalence, and higher baseline payments; less positive trends were associated with more patients aged <16 years, larger lists, and personal medical services contracts. In interaction models, rurality increased whereas higher LTCs decreased IMD's impact.

Deprivation had a positive but diminishing association with payment trends as deprivation increased, moderated by geography and morbidity. Payment uplifts must match inflation. Funding formulas must better compensate for deprivation and morbidity, address the attenuated positive effect of deprivation in practices with more patients with LTCs, and minimise geographical inequalities.