Impacts of provider funding levels and types on demand and supply aspects of access to primary care

Despite growing evidence on how funding influences primary care provider behaviour and patient health outcomes, its effects on access are less known. We assessed the effect of payments to general practices on multiple dimensions of access in England. We used an unbalanced panel of 7,446 general practices between 2015 and 2023, linking payments to patients’ satisfaction with access and characteristics. In line with the Levesque framework, we distinguished between supply-side (provider approachability, availability, and appropriateness) and demand-side (patient ability to perceive need, reach care, and engage with care) aspects of access. We used linear two-way fixed-effects models to estimate the effects of payments, in total and by type (capitation, quality-based, activity-based, others). We estimated heterogeneous effects by stratifying practices into quintiles of need, deprivation, and population size. Higher total payment improved all access domains, with bigger gains in more deprived and in larger practices. Payment types demonstrated distinct patterns across aspects of access and practices. Capitation increased patient ability to reach care, but reduced provider capacity to deliver care in lower-need and in larger practices. Quality‑based payments increased providers’ appropriateness and patients’ engagement in lower‑need and in larger practices. Activity‑based payments showed modest positive associations with access. The positive effects of other payments were driven by dispensing-related components. Effects were attenuated when controlling for unobserved time-varying heterogeneity with interactive fixed-effects. Payment types shape different dimensions of access, with effects varying by population need, deprivation, and size. A balanced payment-mix is essential to support intended context-specific improvements in access.