The provision of additional services in primary care: a cross-sectional study of incentivised additional services, social deprivation, and ethnic group

Veline L'Esperance; Peter Schofield; Mark Ashworth

doi:10.3399/bjgpopen20X101141

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Table 1. Summary of available DES and proportions of practices offering each service, N = 6849

DES	Practices offering service, n (%)
Influenza and pneumococcal immunisations	6844 (99.9)
Rotavirus and shingles immunisation	6839 (99.9)
Meningitis immunisation	6829 (99.7)
Childhood vaccination and immunisations	6820 (99.6)
Pertussis immunisation	6708 (97.9)
Learning disabilities health checks	5776 (84.3)
Minor surgery	5240 (76.5)
Extended hours access	4961 (72.4)
Violent patient services	134 (2.0)
Out-of-area, in-hours urgent care	89 (1.3)

DES = directed enhanced service.

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Table 2. Demographic and practice determinants of DES funding (£/patient): adjusted regression model

Predictor variable	DES funding model: regression coefficient, B (95% CI)
Practice list size (per 10 000 registered patients)	0.44 (0.32 to 0.56)^a
Single-handed practice	–0.01 (–0.26 to 0.24)
Practice staffing (number of staff per 10 000 registered patients)
GPs	0.09 (0.07 to 0.12)^a
Practice nurses	0.15 (0.11 to 0.19)^a
Administrative staff	0.01 (–0.01 to 0.03)
Direct patient care staff (for example, clinical pharmacists)	0.08 (0.05 to 0.11)^a
Age of registered patients, years
0–4	33.2 (26.0 to 40.4)^a
5–14	–0.49 (–4.33 to 3.36)
45–64	7.49 (5.22 to 9.75)^a
≥65	3.30 (1.38 to 5.23)^b
Social deprivation quintiles of registered patients
Deprivation quintile 1 (least deprived)	ref
Deprivation quintile 5 (most deprived)	–0.35 (–0.60 to –0.10)^b
Deprivation quintile 4	–0.09 (–0.30 to 0.13)
Deprivation quintile 3	–0.03 (–0.22 to 0.17)
Deprivation quintile 2	0.02 (–0.16 to 0.21)
Ethnic group of registered patients
Black	–1.45 (–2.92 to 0.02)
Asian	0.65 (0.07 to 1.23)^c
Region
East of England	ref
London	–0.30 (–0.58 to –0.02)^c
Midlands	0.24 (0.01 to 0.47)^c
North East and Yorkshire	0.49 (0.24 to 0.73)^a
North West	0.19 (–0.07 to 0.44)
South East	0.003 (–0.24 to 0.25)
South West	0.81 (0.32 to 1.10)^a
Practice income (£/100 patients)
Capitation payments	–0.01 (–0.02 to –0.01)^a
QOF payments	0.15 (0.13 to 0.18)^a
MPIG payments	0.01 (–0.14 to 0.11)

Assocations with each predictor are adjusted for the effect of all other predictors in the Table. ^asignificant, P<0.001. ^bsignificant, P<0.01. ^csignificant, P<0.05. DES = directed enhanced services. QOF = Quality and Outcomes Framework. MPIG = minimum practice income guarantee.

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Table 3. Demographic and practice determinants of individual components of DES funding (£/patient): adjusted regression model

Predictor variable	Influenza & pneumococcal immunisation	Rotavirus & shingles immunisation	Meningitis immunisation	Childhood immunisations	Pertussis immunisation	Learning disabilities checks	Minor surgery	Extended hours access	Violent patient services	Out of area, in-hours urgent care
Adj. R²: 0.50	Adj. R²: 0.29	Adj. R²: 0.39	Adj. R²: 0.19	Adj. R²: 0.21	Adj. R²: 0.11	Adj. R²: 0.09	Adj. R²: 0.08	Adj. R²: 0.09	Adj. R²: 0.002
Age of registered patients, years (comparator: 15–44)	Regression coefficient, B (95% CI)
0–4	0.48(–1.29 to 2.25)	1.78^a(1.58 to 1.98)	5.24^a(4.95 to 5.53)	18.7^a(16.5 to 20.9)	0.98^b(0.89 to 1.08)	0.09(–0.98 to 1.15)	1.37(–2.95 to 5.69)	2.69(–0.32 to 5.71)	1.39(–1.82 to 4.61)	–0.01(–0.07 to 0.04)
5–14	0.77(–0.18 to 1.71)	–0.22^a(–0.33 to –0.11)	–0.72^a(–0.88 to –0.57)	1.65^b(0.47 to 2.83)	–0.19^a(0.24 to –0.14)	0.80^b(0.23 to 1.37)	–0.004(–2.31 to 2.30)	0.46(–1.14 to 2.06)	–3.04^b(–4.75 to –1.33)	–0.0004(–0.03 to 0.03)
45–64	0.69^c(0.14 to 1.24)	0.04(–0.02 to 0.10)	–0.09(–0.18 to 0.01)	1.95^a(1.26 to 2.65)	0.02(–0.11 to 0.06)	0.24(–0.09 to 0.57)	2.05^b(0.69 to 3.40)	1.36^b(0.42 to 2.30)	1.35^b(0.35 to 2.35)	0.007(–0.02 to 0.01)
≥65	5.71^a(5.24 to 6.18)	0.54^a(0.49 to 0.60)	–0.30^a(–0.38 to 0.22)	–0.79(–1.38 to –0.20)	–0.09(–0.11 to –0.06)	–0.37^c(–0.65 to –0.08)	2.17^a (1.01 to 3.32)	–1.02^c(–1.82 to –0.21)	–2.43^a(–3.29 to –1.58)	–0.003(–0.02 to 0.01)
Social deprivation (most deprived compared with least deprived quintile)	–0.15^a(–0.21 to –0.08)	–0.02^a(–0.03 to 0.02)	–0.03^a(–0.04 to –0.02)	–0.12^b(–0.20 to –0.05)	–0.01^a(–0.02 to –0.01)	0.10^a(0.07 to 0.14)	0.11(–0.04 to 0.26)	–0.24^a(–0.35 to –0.14)	0.03(–0.08 to 0.14)	–0.001(–0.003 to 0.001)
Black ethnic group (compared with White ethnic group)	0.08(–0.28 to 0.44)	–0.02(–0.06 to 0.02)	–0.02(–0.08 to 0.04)	–1.09^a(–1.54 to –0.64)	–0.04^a(0.06 to –0.01)	–0.26^c(–0.47 to –0.04)	–0.66(–1.54 to 0.22)	0.82^b(0.20 to 1.43)	–0.45(–1.10 to 0.21)	0.001(–0.01 to 0.01)
Asian ethnic group (compared with White ethnic group)	0.37^a(0.23 to 0.52)	–0.01(–0.02 to 0.01)	0.01(–0.01 to 0.04)	0.08(–0.10 to 0.26)	–0.02(–0.01 to 0.02)	0.07(–0.02 to 0.15)	0.16(–0.19 to 0.51)	0.06(–0.19 to 0.30)	–0.03(–0.23 to 0.29)	0.002(–0.002 to 0.006)

The B coefficients displayed are adjusted for all predictors included in the original regression model, Table 2. For simplicity, only age, deprivation, and ethnic group predictors are shown in this Table.
Adjusted R2 values refer to values for the regression model for each individual directed enhanced services (DES) component. ^asignificant, P<0.001. ^bsignificant, P<0.01. ^csignificant, P<0.05.