General practice deprivation payments: are rural practices disadvantaged?

The use of the Jarman under privileged area (UPA) scoring system as a means of remunerating general practitioners (GPs) for the additional workload associated with deprivation has been the subject of much debate and criticism. GPs who are based in rural practices often fail to attract any deprivation payments and are particularly aggrieved. They criticise the UPA system for being more sensitive to urban deprivation and therefore inherently biased against rural practice. Electoral wards (EWs) are currently the geographical unit at which Jarman scores are calculated and deprivation payments allocated. However, in the original paper Jarman argued that enumeration districts (EDs) were more appropriate, a view supported more recently by others. This paper asks if the current system fails to detect disadvantage, particularly in rural areas, because it is based at EW rather than ED level.