The National Health Service should be doing more to provide health care where it is needed, according to a research paper published today in the influential BMJ. The study, carried out in Scotland, found more GPs in more affluent areas than serving the poorer half of the population.A team from Glasgow University analysed the availability of primary care according to deprivation and health need in a study based on a sample population of 5.35 million people served by 1,050 general practices and divided into ten groups of equal size according to deprivation. The study revealed that ill health was two and a half times greater in the most deprived group compared to the most affluent.
The researchers, Daniel Mackay, Matt Sutton and Graham Watt, from the university’s Department of General Practice, report that the number of whole time equivalent GP principals is distributed evenly across the population but when non-principals and doctors in training are taken into account, there are 11 per cent more GPs in the more affluent areas compared with the more deprived half of the population.
The research also found there were larger numbers of family doctor practices in the most rural and deprived areas of Scotland but, the paper says, this reflects the higher proportion of single handed and small practices in those areas. The study shows, in fact that practices in deprived areas tend to have younger doctors, fewer female practitioners and that they are involved less in voluntary activities like quality schemes, health service initiatives, and training than are practices in better off parts of the country. The research team believes practices serving the most deprived areas are less likely to volunteer because their time is so taken up with increased levels of morbidity, that without increased medical manpower they are unable or unwilling to take on any additional activities.
Professor Graham Watt said the research helped to explain the persistence of health inequalities in Britain and the health service’s failure to narrow them. The strict rationing of medical manpower, irrespective of need, he said, was putting a major constraint on what the NHS could deliver in deprived areas and as a result general practitioners in those areas were having to ration what they did for patients in the time available.
“Too many NHS agencies have policies and initiatives which fizzle out in the most deprived third of the population. There is an urgent need for NHS initiatives and support systems which reach the parts that current approaches fail to reach,” he said.