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Relationship between general practice capitation funding and the quality of primary care in England: a cross-sectional, 3-year study
  1. Veline L’Esperance1,
  2. Hugh Gravelle2,
  3. Peter Schofield1,
  4. Rita Santos2,
  5. Mark Ashworth1
  1. 1 School of Population Health and Environmental Sciences, King’s College London, London, UK
  2. 2 Centre for Health Economcs, University of York, York, UK
  1. Correspondence to Dr Veline L’Esperance; veline.lesperance{at}


Objective To explore the relationship between general practice capitation funding and quality ratings based on general practice inspections.

Design Cross-sectional study pooling 3 years of primary care administrative data.

Setting UK primary care.

Participants 7310 practices (95% of all practices) in England which underwent Care Quality Commission (CQC) inspections between November 2014 and December 2017.

Main outcome measures CQC ratings. Ordered logistic regression methods were used to predict the relationship between practice capitation funding and CQC ratings in each of five domains of quality: caring, effective, responsive, safe and well led, together with an overall practice rating.

Results Higher capitation funding per patient was significantly associated with higher CQC ratings across all five quality domains: caring (OR 1.14, 95% CI 1.04 to 1.23), effective (OR 1.08, 95% CI 1.00 to 1.16), responsive (OR 1.09, 95% CI 1.02 to 1.17), safe (OR 1.11, 95% CI 1.05 to 1.18), well led (OR 1.13, 95% CI 1.06 to 1.20) and overall rating (OR 1.13, 95% CI 1.06 to 1.19).

Conclusion Higher capitation funding was consistently associated with higher ratings across all CQC domains and in the overall practice rating. This study suggests that measured dimensions of the quality of care are related to the underlying capitation funding allocated to each general practice, implying that additional capitation funding may be associated with higher levels of primary care quality.

  • primary care
  • quality in health care
  • health economics
  • health inequalities
  • primary care funding
  • general practice

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  • Contributors VL, HG, PS, RS and MA contributed to the idea and design of the study. VL and PS led on data analysis with statistical advice from HG, RS and MA. VL produced the first draft of the paper; all coauthors contributed and approved the final draft. VL is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The work was funded by the National Institute for Health Research (NIHR) who funded a Doctoral Research Fellowship for VL (reference, DRF-2017-10-132) and for RS (reference, DRF-2014-07-055). HG and RS were funded by the UK NIHR Policy Research Programme (Policy Research Unit in the Economics of Health and Social Care Systems: Ref 103/0001).

  • Disclaimer The findings presented are independent from the funders who have had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm’s length bodies or other UK government departments.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval not required for the use of aggregate practice level data as included in this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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