Inequalities in access and experience of primary care following ‘top-up’ payments to practices: a retrospective observational study

Background Although the existence of socioeconomic inequalities in health is widely recognised in England, current funding distributions to general practice are thought to inadequately account for patient need. In 2021, Leicester, Leicestershire, and Rutland (LLR) integrated care board began distributing top-up payments to GP practices in the LLR integrated care system (ICS), allocated to account for some of the additional need in practice populations not currently captured. 5.9% of this top-up funding is distributed explicitly with respect to the practice’s share of local socioeconomic deprivation. Aim To assess changes in socioeconomic inequalities in patient access to, and experience of, primary care in LLR ICS since the introduction of additional funding in 2021 relative to the national landscape. Design and Setting A retrospective observational study of English primary care practices using open data sources. Methods Inequalities in practice staffing, patient experience and quality of care were measured across several time points from 2018 to 2024. Outcomes were assessed in LLR ICS, 10 comparator ICSs, and at a national level. Inequality was assessed using the slope index of inequality with respect to perceived funding need in LLR, and with respect to deprivation. Results A total of 5,419 practices open in England between 2018–2024 with at least 500 patients were included, with 118 in LLR ICS. Inequalities indicating higher staffing, better patient satisfaction, and higher QOF achievement outcomes in less deprived practices were identified both nationally and in LLR ICS. No changes in inequality in LLR ICS were observed following the introduction of top-up payments. Conclusion Small amounts of additional funding to primary care were not able to address the inequalities that exist in staffing, experience or quality of care. Further work is needed to identify ways to provide equitable funding across primary care.