Benchmarking can help PCTs tackle deprivation and achieve performance and funding practices that compare with the best, says Nigel Crew

Health inequalities and the failure to distribute resources in accordance with need have been well publicised. However, a number of primary care trusts in the South West are determined to tackle this issue by taking a more systematic approach to benchmarking their funding levels and performance. Benchmarking - which in essence means trusts comparing performance and trying to emulate best practice - will require the development of performance indicators.

With the advent of alternative provider medical services contracts, PCTs have the option to link a higher proportion of the contract value to the underlying patient needs, and to performance indicators that assess how well that need is being addressed.

This could include funding related to actual disease incidence (factoring in deprivation and disease prevalence), rather than simply using theoretical needs indicators driven from demographic models.

Performance management can be implemented either contractually or by developing a complementary monitoring process that clearly articulates performance expectations and goals.

The challenge is to reduce health inequalities without rewarding poor performance. This enables PCTs to evaluate GP behaviour against the whole funding envelope - GP contract, prescribing and practice-based commissioning.

While there are undoubtedly contractual constraints on how quickly resources can be redistributed between practices, PCTs can develop a systematic approach to performance evaluation and a more rational basis for resource allocation.

The process is as much about explicitly recognising and rewarding good performance as identifying where acceptable standards are not being met.

The areas with the greatest health needs invariably have the worst services, with few incentives for GPs to work in deprived areas, where the population health needs are intrinsically harder to address and patient turnover can he high.

Systematically measuring performance against investment should begin to reduce health inequalities and improve outcomes.