Practices serving deprived populations are more likely to be single-handed, more likely to be reliant on older GPs and score lower in CQC ratings and QOF targets, a report from the Health Foundation think tank says.
Half a century after GP Dr Julian Tudor Hart coined the phrase 'inverse care law' to describe his analysis that 'availability of good medical care tends to vary inversely with the need for it in the population served', the report finds that this law 'persists in general practice today'.
The findings are a stark illustration of the health inequality gap exposed during the COVID-19 pandemic, with the virus hitting people in the UK's most deprived areas hardest.
GP funding
Funding per registered patient is similar for practices in the most and least deprived areas is similar, the report says - but once funding is weighted for need, a significant gap emerges.
After adjusting for 'increased workload associated with greater health needs in poorer areas', researchers found that practices in deprived areas receive 'around 7% less funding per need adjusted registered patient' than practices in better-off areas.
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The report also found that practices caring for patients in deprived areas have lower numbers of GPs per patient. It warns: 'After accounting for different levels of need, a GP working in a practice serving the most deprived patients will on average be responsible for the care of almost 10% more patients than a GP serving patients in more affluent areas.'
Demand for appointments is similar across deprived and affluent areas, the report shows.
Health inequality
As a result, patients in deprived areas are simply less likely to see a GP when they need an appointment in primary care. The report reveals: 'Patients attending practices serving more deprived populations are less likely to have an appointment with a GP and more likely to have an appointment with a nurse than those visiting practices serving less deprived populations.'
GPonline reported earlier this year on evidence that some of England's most underdoctored areas are heavily reliant on older GPs and doctors in BAME groups - leaving an already threadbare workforce potentially at increased risk during the pandemic.
The Health Foundation report adds further detail on the fragility of general practice in deprived areas - highlighting that practices serving these populations are 'typically smaller' and more than three times as likely to be single-handed.
The report highlights - as analysis by GPonline has previously shown - that GP practices in many underdoctored areas have compensated by recruiting more nursing staff.
It also highlights the heavy reliance on older GPs in deprived areas. 'There are a disproportionate number of older GPs, particularly those aged 65 and older, working in the most deprived areas,' it says.
'Younger GPs tend to be working in the most affluent areas. If left unaddressed, this trend risks further exacerbating existing inequalities in GP supply as these older GPs working in areas of high deprivation eventually leave the workforce.'
