Access to health care in England: continuing inequalities in the distribution of GPs.
BACKGROUND
One of the successes of the National Health Service is that the distribution of general practitioners (GPs) corresponds much more closely to the size of the local communities than it did before 1948. However, more should be done to reflect the fact that different populations have variable needs for GPs. The aim of this paper is to estimate the relative need for GPs by linking evidence from individual utilization data to the characteristics of small areas.


METHODS
Statistical models of GP utilization were developed from household survey data on 12729 adults representative of the English population. The odds ratios derived from the models were combined with Census information for Family Health Services Authorities (FHSAs) to calculate a need indicator, which was used to estimate the number of GPs 'needed' in an area for comparison with the actual distribution.


RESULTS
The utilization of GPs is associated with morbidity, demographic and socioeconomic variables. The needs indicator derived from the model of GP utilization varies from 1.66 to 2.40 with a mean of 2. Substantial changes in the distribution of Gans are required to reflect the relative need for them. For example, in relative terms, Cornwall and the Isles of Scilly has an excess of GPs of almost one-fifth whereas Rotherham has a shortfall of more than one-third.


CONCLUSIONS
The findings in this paper suggest that there are still considerable inequalities in access to GP services in England in relation to need.
Benzeval
M
M
King's Fund Policy Institute, London.
Judge
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006707:Homes for the Aged; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009735:Nursing Homes; D016017:Odds Ratio; D012959:Socioeconomic Factors; D000078329:Workforce