Health inequalities. Volume II, Written evidence / House of Commons, Health Committee.

  • Great Britain. Parliament. House of Commons. Health Committee
Date:
c2008
Catalogue details

Licence: Open Government Licence

Credit: Health inequalities. Volume II, Written evidence / House of Commons, Health Committee. Source: Wellcome Collection.

    12/370 (page 4)
    Access and Health Inequalities 28. There is a strong correlation between areas with fewest primary care clinicians and those with worse health outcomes and high levels of deprivation. The number of primary care professionals by area is a cross government headline indicator identified by the Programme for Action. 29. The interim Darzi review published in September outlined a package of new measures to improve access to ensure GP practices across the country meet the needs of their local communities and deliver further improvements for patients. 30. These improvements include investing £250 million to deliver at least 100 new GP practices in the most deprived areas—those with fewest GPs and nurses, poorest health outcomes and lowest patient satisfaction—and up to 150 GP-led health centres across the country to increase capacity and improve service responsiveness and quality. 31. A national review is also underway to identify the reasons behind lower levels of satisfaction in accessing GP services, reported by people from BME groups. A report including recommendations for action will be produced in early 2008. QOF and Health Inequalities 32. The Quality and Outcome Framework (QOF) already addresses the need to reduce health inequalities. The recorded prevalence of a disease affects how much money a practice receives for the relevant QOF points. Therefore if recorded prevalence reflects local expected prevalence, practices serving a population with greater need get more money. PCTs are also able to develop local quality frameworks in agreement with their contractors in order to address health priorities for their local population. 33. Although there are limitations to the data, QOF achievement data shows that QOF scores for practices serving the most disadvantaged populations are catching up with those of practices serving the least disadvantaged populations. Recent research shows that QOF scores between affluent and deprived areas are small and of relatively little clinical significance. 34. Continuous improvement is an underpinning concept of the QOF. The Darzi review will also be looking at how to reshape incentives to provide a stronger focus on health outcomes; whether there should be an independent process for setting and reviewing outcome measures in the framework; and whether there should be greater flexibility for PCTs in setting outcomes that reflect local needs and priorities. Practice Based Commissioning 35. Practice Based Commissioning (PBC) can contribute to reducing health inequalities. It gives clinicians who are placed at the heart of communities, the tools to plan and shape the nature and range of services available to their local practice population so that these are tailored in a way that improves health outcomes and better meets local needs. In some cases, practices may also become key providers of community-based services in response to those needs. 36. By harnessing practices’ professional experience of delivering care, PBC has a key role to play in delivering improved health outcomes through services designed around the needs of local people. Clinical engagement is central to World Class Commissioning that aims to enhance systematically the effectiveness of PCTs and PBCs to commissioning high quality and personalised services that will reduce health inequalities and improve health outcomes and well-being for their local population. 37. World Class Commissioning focuses on commissioning for outcomes. PCTs will be expected to choose, in partnership with practices and local authorities, up to 15 indicators relating to health improvement: reducing inequalities, increasing public confidence and patient satisfaction. PBC will contribute to this prioritisation of local health outcomes and provide clinical input to transform care at a local level. This will help ensure that the greatest priority is placed on those whose needs are greatest. THE EFFECTIVENESS OF PUBLIC HEALTH [ISSUE: the effectiveness of public health services at reducing inequalities by targeting key causes such as smoking and obesity, including whether some public health interventions may lead to increases in health inequalities; and which interventions are most cost-effective ] KEY MESSAGE—public health is most effective when action for health improvement is matched by action to tackle health inequalities 38. Public health has a role to play in reducing health inequalities through a range of interventions as set out in the Choosing Health (2004) White Paper. Choosing Health seeks to raise people’s aspirations and improve their lifestyles using tools such as social marketing. Personalising packages of support are key and new mechanism and tools have been developed, such as health trainers to provide personal support for people in disadvantaged groups and areas; health literacy programmes to improve capability and uptake of services; and, LifeCheck to pilot health needs.