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

2. HEALTH INEQUALITY IMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

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

4. HEALTH INEQUALITY IMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

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

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

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

8. HEALTH INEQUALITY IMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

9. QUALITY & OUTCOMES FRAMEWORK OVERVIEW OF THE QUALITY & OUTCOMES FRAMEWORK PRIMARY CARE AND HEALTH DISPARITY 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

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

11. IMPACT ON INEQUALITIES SOURCE: DORAN ET AL. LANCET 2008; 372: 728-736. REPORTED ACHIEVEMENT 2004/52005/62006/7 PRIMARY CARE AND HEALTH DISPARITY

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

13. NON-INCENTIVIZED ACTIVITIES SOURCE: DORAN ET AL. BMJ 2011; 342: D3590. ACHIEVEMENT ABOVE PREDICTED PRIMARY CARE AND HEALTH DISPARITY 2004/52006/7 NO EFFECT

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

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

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

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

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