The RAWP review: RAWPing Primary Care; RAWPing the United Kingdom

In late 1985 the Secretary of State for Health and Social Services set up a review of the resource allocation formula created by the Resource Allocation Working Party (RAWP) in 1976. This review may be completed early in 1987 and will raise major issues about the efficiency of the NHS and equality of access to healthcare. Two issues seem likely to be omitted from this Review. The first is the consideration of the equity aspects of primary care. The Family Practitioner Services budget is open ended and demand determined. It was excluded from the RAWP process because of the nature of the general practitioners' contract and has led to the continuation of great inequalities in access to health care. These inequalities are analysed in the first part of this paper which shoes the effects of applying the RAWP formula to the primary care budget. A second issue ignored by the RAWP review is the maintenance of great inequalities on access to health care in the constituent parts of the United Kingdom. The health services of ENgland, Scotland, Wales and Northern Ireland are funded independently. Although each country has its own RAWP-type formula, the initial allocations are now RAWPed. As a consequence the Scots and the Irish have resource allocations in excess of those of England. The second part of the paper shoes that if the aggregated UK health care budget was allocated using the RAWP formila, Scotland and Northern Ireland would lose significant amounts of resources.