RT Journal Article SR Electronic T1 The provision of additional services in primary care: a cross sectional study of incentivised additional services, social deprivation and ethnicity JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP bjgpopen20X101141 DO 10.3399/bjgpopen20X101141 A1 Veline L'Esperance A1 Peter Schofield A1 Mark Ashworth YR 2020 UL http://bjgpopen.org/content/early/2020/11/12/bjgpopen20X101141.abstract AB Background: Primary care in England is contracted to provide essential services; many practices also provide additional services. The optional nature of additional services may result in inequitable service delivery. Aim: To determine the range of additional service activity and equity of service provision. Design and Setting: Cross-sectional analysis of data from general practices in England, 2018/19. Methods: Additional services, termed ‘Direct Enhanced Services’ (DES), defined in terms of activity level and measured as total DES funding per registered patient. Linear regression modelling was used to explore the relationship between DES activity, practice and population characteristics. Results: Data were available for 6868 practices providing up to 10 DES. Highest DES provision was for influenza and pneumococcal immunisation (99.7%) and childhood immunisation (99.3%); lowest provision was for extended hours access (72.2%), violent patient services (1.9%) and out-of-area urgent care (1.3%). Mean DES funding was £6.25 per patient. In deprived areas, DES funding was £0.35 lower (95% confidence interval: £0.60, £0.10) per patient (most versus. least deprived quintiles); ethnicity related differences were not significant. DES funding was higher in practices with more GPs or practice nurses, per patient. In deprived communities, there was less immunisation activity (including influenza, pneumococcal, meningitis, childhood, rotavirus and shingles immunisation) and provision of extended hours access; however ‘learning disability checks’ provision was greater in these communities. Conclusions: Additional service provision is lower in deprived areas (notably for immunisations and some aspects of access) but higher in better staffed practices. Voluntary quality schemes may contribute to widening health inequalities.