title: The effect of deprivation on variations in general practitioners' referral rates: a cross sectional study of computerised data on new medical and surgical outpatient referrals in Nottinghamshire.
abstract: OBJECTIVE
  To determine the effect of deprivation on variations in general practitioners' referral rates using the Jarman underprivileged area (UPA(8)) score as a proxy measure.
  
  
  METHODS
  Cross sectional survey of new medical and surgical referrals from general practices to hospitals (determined from hospital activity data).
  
  
  METHODS
  All of the 183 general practices in Nottinghamshire and all of the 19 hospitals in Trent region.
  
  
  METHODS
  The relation between the referral rates per 1000 registered patients and the practice population's UPA(8) score (calculated on the basis of electoral ward), with adjustment for the number of partners, percentage of patients aged over 65 years, and fundholding status of each practice.
  
  
  RESULTS
  There was a significant independent association between deprivation, as measured by the UPA(8) score, and high total referral rates and high medical referral rates (P < 0.0001). The UPA(8) score alone explained 23% of the total variation in total referral rates and 32% of the variation in medical referral rates. On multivariate analysis, where partnership size, fundholding status, and percentage of men and women aged over 65 years were included, the UPA(8) score explained 29% and 35% of the variation in total and medical referral rates respectively.
  
  
  CONCLUSIONS
  Of the variables studied, the UPA(8) score was the strongest predictor of variations in referral rates. This association is most likely to be through a link with morbidity, although it could reflect differences in patients' perceptions, doctors' behaviour, or the use and provision of services.
authors.affiliation: Department of General Practice, Medical School, Queen's Medical Centre, Nottingham. julia.h-cox@nottingham.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: Hippisley-Cox
authors.forename: C
authors.initials: C
authors.lastname: Hardy
authors.forename: M
authors.initials: M
authors.lastname: Pringle
authors.forename: K
authors.initials: K
authors.lastname: Fielding
authors.forename: R
authors.initials: R
authors.lastname: Carlisle
authors.forename: C
authors.initials: C
authors.lastname: Chilvers
mesh_terms: D004739:England; D005194:Family Practice / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D011203:Poverty; D011204:Poverty Areas; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000706:statistics & numerical data*