GPs at the Deep End North East North Cumbria

Clinical lead Martin Weatherhead shares his thoughts on how the Deep End NENC can advocate for our region, practices and patients.

23rd April 2021

The inverse care law has proved difficult to overturn, but one of the audiences NENC Deep End hope to influence are the decision makers who control funding allocation. However, we can’t lose sight of the fundamental importance of improving the quality of the health care experienced by our patients.

Two of our stated aims are to:

  • Advocate for funding allocation to take account of deprivation more meaningfully.
  • Advocate for our patients to have to have the right services when they may lack the resources to advocate for themselves.

How can we meet the challenge and advocate effectively?

  1. As a network we have links into many of the levels at which our influence can have an impact but how do we ensure our influence is recognised as being essential beyond our personal attendance: how do we become the required Deep End voice and not an attendee with Deep End expertise?
  2. How do we build an off the shelf evidence bank that can be used whenever the same old questions are raised? What does that evidence base look like?

We suspect that the increased prevalence of mental and physical health poly-comorbidity associated with deprivation links to increased health resource consumption at least as powerfully as age yet indicative and real GP budgets are more based on age. How do we change this?

We seem to see a high number of ‘DNA’s (Did Not Attend). When our own practice staff ask at what point does personal responsibility begin and our responsibility to chase non-attendance end, what is the evidence based answer? And what resource do we need to manage the problem?

We don’t have all the answers but can start to think of some of the opportunities at different levels:

Nationally: very difficult
  • How can we influence GMS contract negotiation?
  • Weighted list size calculation lies at the heart of the funding inequality.
  • We have an advocate involved in the research group looking at how inequalities should be reflected in funding allocation.
  • What links do we have with LMC’s?
  • Do we act in tandem with other Deep End groups?
Regionally
  • How do we influence the ICS?
  • How do we get a seat at the table in our own right? Via inequalities?
  • Can we get regional agreement regarding adjusting weighted indicative budget allocation?
Place/CCG
  • How can we influence Quality Premium decisions?
  • Do we influence indicative budget allocation at Place level?
  • Do we raise the profile of inequalities at the level of health pathway design?
PCN
  • Reducing inequalities is at the core of the DES (Direct Enhanced Services contract).
  • How do we get our colleagues in non-Deep End practices to understand that addressing the additional challenges we face will help achieve the aims of the DES?
  • Do we improve population screening uptake at PCN level by focussing on inequalities?
Practice
  • Do our staff understand the challenges faced by the population we look after?
  • Do we practice what we preach when it comes to removing patients or by our response to noncompliance with planned care?

These are the questions and conversations that we need to be having.