Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1991 Feb 16;302(6773):393-6.
doi: 10.1136/bmj.302.6773.393.

Designing a deprivation payment for general practitioners: the UPA(8) wonderland

R A Carr-Hill  1 , T Sheldon
Affiliations

Designing a deprivation payment for general practitioners: the UPA(8) wonderland

R A Carr-Hill et al. BMJ. .

Abstract

Objective: To analyse critically the deprived area payment introduced in the new general practitioner contract. The payment formula is based on the Jarman underprivileged area index (UPA(8)) and aims at compensating general practitioners for increases in workload.

Design: Evaluation of the deprived area payment against the stated policy objective with a set of criteria for developing resource allocation formulas.

Main outcome measures: The degree to which the components of the Jarman index predict the workload of general practitioners; whether construction of the index is sensible and comprehensible; and how the formula incorporates the index and is likely to work in practice.

Results: The fact that the index relies on census data and the way the weighting was derived means that the formula will not accurately reflect the workload. The use of statistical transformations obscures the original policy intent. There has been no validation to support the application of the index as part of a national policy. The payments are not linked to the quality of service provided and may have the perverse effect of increasing list size.

Conclusion: The formula used as the basis of the deprived area payments is poorly suited to the policy objective of compensating general practitioners for increases in workload. More research is urgently needed to enable the effect of the payment to be monitored and a more empirically sound set of incentives to be developed.

PubMed Disclaimer

Comment in

  • Second thoughts on the Jarman index.
    Smith GD. Smith GD. BMJ. 1991 Feb 16;302(6773):359-60. doi: 10.1136/bmj.302.6773.359. BMJ. 1991. PMID: 2004137 Free PMC article. No abstract available.
  • Jarman index.
    Jarman B. Jarman B. BMJ. 1991 Mar 2;302(6775):527. doi: 10.1136/bmj.302.6775.527-a. BMJ. 1991. PMID: 2012854 Free PMC article. No abstract available.
  • The Jarman index.
    [No authors listed] [No authors listed] BMJ. 1991 Mar 16;302(6777):661. BMJ. 1991. PMID: 2012894 Free PMC article. No abstract available.

References

    1. Br Med J (Clin Res Ed). 1983 May 28;286(6379):1705-9 - PubMed
    1. Br Med J (Clin Res Ed). 1984 Dec 8;289(6458):1587-92 - PubMed
    1. Br Med J (Clin Res Ed). 1985 Jun 8;290(6483):1714-6 - PubMed
    1. Br Med J (Clin Res Ed). 1985 Sep 14;291(6497):709-11 - PubMed
    1. Br Med J (Clin Res Ed). 1986 May 17;292(6531):1313-5 - PubMed

Publication types

LinkOut - more resources