Practices in urban areas in England score consistently lower than their counterparts in the affluent Home Counties or rural areas, quality framework data show.
The 30 PCTs in the bottom 10 per cent for average quality scores in 2005/6 before reconfiguration are all in urban areas, often concentrated in major English cities.
Almost one in three of these PCTs are in London, four are in and around Manchester, three in Liverpool and two in Sheffield. Other low-scoring PCTs are in Birmingham, Hull and smaller manufacturing towns.
PCTs with high average achievement in the quality framework are largely in areas categorised by the Office of National Statistics as rural, affluent southern England or prospering small towns.
The two lowest scoring areas in Northern Ireland also cover urban and deprived areas. Practices in north and west Belfast scored 950 points, and those in Craigavon and Bainbridge scored 938 points.
In Wales low scores are closely linked to deprivation, but not specifically to cities, while in Scotland rural areas seem to score lowest, reversing the English trend.
Head of the BMA’s health economics and research unit Jon Ford said: ‘It is harder for urban environments to achieve high scores because of mobile populations.’ Average quality scores in the bottom 30 PCTs range from 910 points to 982.
GPC negotiator Dr Richard Vautrey said: ‘It is much harder to provide medical services in urban areas. There is higher morbidity and patients don’t engage in the same way as in rural areas.’
City and Hackney LMC chairman Dr Kambiz Boomla said the gap in scores was ‘in one sense obviously unfair’.
He called for changes to exception reporting rules to exclude patients from quality data for a longer period of time after registration. Patients count towards quality scores after nine months.
He added: ‘Enhanced schemes provide additional incentives for practices in challenging areas and compensate for low quality scores. But PCTs are finding this harder now the NHS is in deficit.’