• GP practices serving more socioeconomically deprived patient populations receive similar funding per registered patient to those serving less deprived patient populations. Once these populations are adjusted to account for increased workload associated with greater health needs in poorer areas, practices serving more deprived populations receive around 7% less funding per need adjusted * registered patient than those serving less deprived populations. * Measuring health need directly is not possible. In our analysis we use workload as a proxy for need. This has limitations, but is consistent with the methodology used in the Carr-Hill resource allocation formula for general practice. Briefing: Level or not? 2 • GP practices serving more deprived patient populations on average earn fewer quality and outcomes framework (QOF) points, have worse Care Quality Commission (CQC) ratings and lower patient satisfaction scores than practices serving less deprived populations. These measures of assessing quality may themselves be affected by deprivation (for example increased patient deprivation may make it harder to achieve high QOF scores). Further research is needed across other aspects of quality to explore whether patients living in more deprived areas receive a systematically lower quality of care.

In times of relatively low public spending in the UK since 2009-2010, health spending has been protected above all else. At the same time budgets for education, housing and public safety have fallen. This is in part due to the presence of growing demand for healthcare: while the population has increased by around one-third since 1950, healthcare spending as a share on national income has more than doubled. Continuing increases in quantity and complexity of the use of the health service as well as the unit costs indicate that these pressures will not be alleviated any time soon. However, there are clear benefi ts to investing in health; research fi nds that a 10% increase in health spending was associated with a gain of 3.5 months of life expectancy across the Organisation for Economic Cooperation and Development from 1995 to 2015. In this paper, we discuss the potential value of additional spending.

Decisions about the appropriate amount to spend on health require more than a simple comparison with what other countries spend, argue John Appleby and Ben Gershlick

The pressures -from a growing and ageing population, from rising expectations and from increasing cost pressures -facing the NHS over the next 15 years are substantial.Meeting the pressures under the Health Foundation's 'modernised NHS' scenario, which allows for modest improvements in NHS services, would increase expenditure on health by an estimated 2.6% of GDP by 2033-34. This is equivalent to £56 billion in today's terms, or £2,000 per year for each household in the UK. These figures are substantially larger than recent political pledges to the NHS.Just maintaining services at their current level is deemed to require a substantial increase in funding, much of which would need to be found in the next five years.