Abstract
Primary care in England is contracted to provide essential services. Many practices also provide additional services, termed 'directed enhanced services' (DES), for extra income. The optional nature of DES may result in inequitable service delivery. To determine the range of DES activity and equity of service provision. A cross-sectional analysis of data from general practices in England took place from 2018-2019. DES were 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. Data were available for 6873 practices providing up to 10 DES in the initial sample. Due to negative funding amounts and a list size of ≤750 registered patients, 24 practices were excluded. Of the final sample (n = 6849), highest DES provision was for influenza and pneumococcal immunisation (99.9%), pertussis immunisation (97.9%), rotavirus and shingles immunisation (99.9%), meningitis immunisation (99.7%), and childhood immunisation (99.6%); lowest provision was for extended hours access (72.4%), violent patient services (2.0%), and out-of-area urgent care (1.3%). Mean DES funding was £6.25...Continue Reading
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