Bristol GP income 2011-12, performance and patient need

Commentary
This local analysis has demonstrated clear large disparities in practice core incomes. These differences may reflect quite large differences in the services provided, with higher earning practices able to provide better resources for their patients. It could be that higher core incomes lead to higher incomes for the partners in those practices, but we do not have information on GP earnings as this is confidential to practices. PMS contracts were phased in over 6 years, and I suspect have been poorly managed by PCTs. I can find little evidence that the differences are needs related. I have also been unable to detect much evidence that higher core practice income improves performance over a range of measures.
Statistical Significance of associations
The standard error of a correlation R is SQRT[(1-R2)/(n-2)]. So for a sample size of 57, r=0.3 is significant at 5% level, R=0.25 is just outside the 5% significance level. Lower correlations are nons-significant. Multivariate analysis might disentangle some of the confounding in these analyses, but it is unlikely to uncover an association not seen in bivariate analyses.
Political significance of these analyses
Not every practice will agree with these results. The higher earners will probably argue that I have not been able to measure the effect on their patients of their higher core income. Lower earners will be able to say that they perform just as well on lower core incomes. Over the last few years, practice incomes have been falling, and now is not the time to use these analyses to argue for cuts in GP resources. A reduction in inequity is irrefutable. We know that GPs dislike but respond very well to performance related pay (e.g. QOF). My conclusion is that we need to find ways to reward good practice without introducing a whole raft of new targets, and without destabilising primary care.
Further research
More work is needed to understand these results. This might involve looking at practice workloads, GP partner earnings, and the best way to allocate primary care resources in an equitable manner.


Recent Developments February 2014

NHS England has a reported a review of PMS contracts(ref 7) with guidance for Local Area Teams who are expected to review all PMS contracts inside 2 years with a view to improving equity and fairness.  In the context of falling GP incomes (ref 6), the overall impact is intended to "sustain current levels of investment at a National level". 

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