New analysis by the Nuffield Trust think tank reveals ‘concerning’ discrepancies between the standard of GP care people receive in poor areas compared to their counterparts in richer areas, raising questions about how well the NHS meets its founding principles of equity.
The research, carried out for the Financial Times, finds that the NHS does well in providing equal access to hospital care, including on the totemic four-hour A&E target and the 18 week waiting time target for planned care, and that overall patient experience of general practice remains good.
But there are significantly fewer GPs per head in poorer areas of England than in richer areas, people find it harder to get a GP appointment and they are less likely than their richer counterparts to have a good experience of visiting their GP. Meanwhile, people in poorer areas are more likely than their wealthier counterparts to enter hospital in an emergency, rather than as a scheduled patient. This might suggest they are not receiving enough planned care
The Nuffield Trust says this is likely to be driven by a number of reasons, including the challenges in recruiting GPs in certain areas of the country and the relative complexity of investing in GP surgeries as small business compared to state-run hospitals. But the think tank also suggests that the relatively crude financial formula that determines GP funding may not be meeting the needs of poorer areas, compared to the more sophisticated funding formula for hospital care.
Key findings include:
- There are significantly fewer GPs per head in the most deprived areas compared to the least deprived. In the least deprived fifth of CCGs, there were 53 GPs per 100,000 patients, compared to 47 in the most deprived fifth. Put another way, this means that there were an average of 1869 patients on GP lists for each doctor in the most affluent CCGs, compared to 2125 in the most deprived.
- People in the most deprived fifth of CCGs saw the GP they wanted to see 52% of the time, compared to 59% in the last deprived fifth.
- Fewer than 70% of people in the poorest areas said they had a ‘very’ or ‘fairly’ good experience of making a GP appointment, compared to over 75% of people in the richest areas.
- One in seven people in the poorest areas were unable to get a GP appointment, compared to one in ten in the richest areas.
- On key measures of hospital care there is no statistically significant link between deprivation and how long people wait for treatment, either on the four-hour A&E target or the 18 week referral to treatment target.
- Emergency admissions were nearly 30% higher in the most deprived fifth of CCGs, compared to the least deprived fifth. But planned and waiting list admissions did not have a statistically significant link with deprivation.
Commenting on the findings, Nuffield Trust Chief Executive Nigel Edwards said:
“Compared to other countries, international studies show the UK does a good job at providing equal healthcare for all. Nonetheless, this analysis shows there are still some concerning discrepancies between the standards of care rich and poor receive from some NHS services. Even though the picture is positive regarding hospital care and the overall levels of experience with general practice, GPs in poorer areas seem to be spread more thinly and people are reporting a worse experience of care.
“As the NHS gets to work on its Long Term Plan for the next ten years, exploring exactly why these differences exist will be key to ensuring the health service meets the needs of people regardless of their income or background”.
Author and Nuffield Trust policy analyst Mark Dayan said:
“It’s possible that these inequalities are driven by funding formulas not doing enough to steer general practice money to the areas that need it. It might also be that we’re not doing a good job of incentivising GPs to work where the job can seem most demanding, meaning the chronic shortage of staff hits the poorest areas.
“These problems do not seem insurmountable. Our research shows the NHS has managed to achieve fairly equal access to hospital care, so after all the pledges to reduce inequalities we expect to see in the Long Term Plan there’s every reason to think NHS leaders can and should sort out this issue.”
Notes to editors
The analysis, carried out exclusively for the Financial Times, draws on NHS data on waiting times, staffing, hospital activity and outcomes, as well as the results of the GP Patient Survey, filled out by more than 800,000 people in January to March 2017. It plots these measures against national data on deprivation profiles.