The Active Practice Charter (APC), introduced by the Royal College of General Practitioners (RCGP), aims to embed physical activity (PA) promotion within primary care, theoretically enhancing both patient health and practice quality. However, the effectiveness of this voluntary accreditation and its social equity implications remain under-researched. This study aims to assess the independent relationship between APC accreditation and three quality outcomes (Quality and Outcomes Framework (QOF) score, patient satisfaction rate and Care Quality Commission (CQC) rating) while exploring whether this relationship varied across the socioeconomic deprivation spectrum. This is the first large-scale empirical assessment of the APC. This cross-sectional observational study analysed data from 6,063 General Practice (GP) practices in England (523 APC-accredited). Initial non-parametric bivariate tests showed APC practices tended to have larger list sizes, were located in less socioeconomically deprived areas, and served a greater proportion of older adults than non-APC practices. Multivariable regression (Ordinary Least Squares and Ordinal Logistic) was used to assess the main effect of APC status, controlling for size, socioeconomic deprivation, and patient demographics. Equity implications were explored through moderation analysis and stratification analysis across ten deciles of the Index of Multiple Deprivation (IMD). When compared with non-APC practices, APC practices had statistically significantly lower IMD scores, higher proportions of older adults and a higher proportion of White ethnicity. This implies some socioeconomic inequities in the take-up of the APC programme across England. In our main effects model, APC accreditation had a statistically significant and robust positive association with patient satisfaction (β = 1.979, p < 0.001) and CQC ratings (OR = 1.321, p < 0.001), and only a small but significant association with QOF points (β = 0.893, p < 0.01). Moderation analysis suggested uniform effects across the socioeconomic deprivation spectrum, although followup stratification analysis revealed some evidence of social inequity, with the positive effects on patient satisfaction being concentrated in the mid-range of socioeconomic deprivation. APC accreditation is associated with higher levels of patient experience and regulatory success, strengthening the case for its promotion. There was evidence of socioeconomic patterning in APC uptake, but no statistically significant global interaction in outcomes by deprivation. Future policy should focus on providing dedicated resources and tailored support to overcome resource constraints in socioeconomically deprived settings to ensure the APC does not inadvertently widen existing quality gaps.
Mayaud et al. (Sun,) studied this question.