Deprivation and primary care network performance: a national cross-sectional study of the Investment and Impact Fund scheme

Background Health inequalities persist across England, with primary care providers in more deprived areas facing greater challenges. A shared incentive scheme, the Investment and Impact Fund (IIF), was introduced for primary care networks (PCNs) with aims to improve population health and care delivery, but its equity impact remains unknown.

Aim To assess the relationship between socioeconomic deprivation and attainment in a shared incentive scheme for primary care networks in England during the 2022/23 financial year.

Design & setting Cross-sectional study of PCNs in England.

Method PCNs were stratified into Index of Multiple Deprivation (IMD) quintiles. Univariate and multivariate regression models explored the association between deprivation and incentive attainment, adjusting for confounders including PCN characteristics, non-IMD socioeconomic factors and chronic disease prevalence.

Results PCNs in less deprived areas consistently outperformed those in more deprived areas, with a 39.32-point gap between the least and most deprived quintiles, equating to a shortfall of £7,863.20 in funding, or £0.16 per patient. After adjusting for confounders, PCN deprivation remained significantly associated with lower point attainment. Greater GP workload and disease burden were linked to reduced IIF performance.

Conclusion There is inequality in IIF attainment by socioeconomic deprivation in England, persisting after adjustment for PCN characteristics and chronic disease prevalence. To address disparities, policy should consider rewarding relative improvements rather than absolute attainment, alongside targeted structural support such as workforce investment.