Health systems like the UK's NHS aim to provide high-quality care for all groups of patients. Consequently, it is important to examine the impact of new initiatives in the delivery of health care on health disparities. A recent study by Fiona Hamilton and colleagues published in the Journal of Ambulatory Care Management examined the impact of a major pay-for-performance initiative introduced into UK primary care in 2004 on disparities in diabetes management. The study used data from the UK General Practice Research Database, which is widely used for epidemiological and health services research. The authors found that existing disparities in risk factor management (HbA1c, blood pressure, cholesterol) narrowed between men and women. Younger patients (under 45 years of age) with diabetes appear to have benefited less from Pay for Performance incentives than older patients, resulting in some widening of existing age group disparities. Patients living in affluent and deprived areas appeared to have derived a similar level of benefit from pay for performance. They concluded that a realignment of financial incentives may be required to further reduce health disparities. This could include a greater focus on outcome-based targets, such as HbA1c control and larger incentives for GPs working in more deprived areas.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
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