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NHS failing to provide health care according to need

Deprivation and volunteering by general practices: Cross sectional analysis of a national primary care system BMJ Volume 331, pp 1449-50

BMJ

The NHS needs to do more to provide health care according to need, argue researchers in this week's BMJ.

They analysed the availability of primary care according to deprivation and health need in Scotland. Their study was 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.

They show that ill health is two and a half times greater in the most deprived group compared to the most affluent, but the number of whole time equivalent GP principals is distributed evenly across the population.

However, including non-principals and doctors in training, there are 11% more GPs in the more affluent compared with the more deprived half of the population.

Although they found larger numbers of practices in the most rural and deprived areas, this reflects the higher proportion of single handed and small practices in such areas, say the authors.

In fact, they show that practices in deprived areas tend to have younger doctors, fewer female doctors, and less involvement in voluntary activities such as quality schemes, health service initiatives, and training than practices serving more affluent areas.

Practices serving the most deprived areas are less likely to volunteer because they are so consumed by dealing with increased levels of morbidity, without increased levels of medical manpower, that they are unable or unwilling to take on additional activities, they write.

Professor Graham Watt, from the Department of General Practice at Glasgow University commented: "Our paper helps to explain the persistence of health inequalities in the UK, and the under-achievement of the NHS in narrowing these inequalities.

The strict rationing of medical manpower, irrespective of need, places a major constraint on what the NHS can deliver in deprived areas. It follows that general practitioners in such areas have to ration what they do 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 concludes.

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