Primary care teams work harder in deprived areas.
BACKGROUND
The NHS Plan promises an equitable distribution of resources within primary care. To inform the debate on the extent to which resources should be redistributed we examined the association between primary care activity and deprivation. We used the natural experiment of the organization of primary care in Mansfield, Nottinghamshire, where town centre general practices have patients from electoral wards with a range of socio-economic characteristics who are subject to the same degree of supplier-induced demand and variations in data quality.


METHODS
We used one year's prospective data for two practices with 20,106 patients from 15 electoral wards. We performed linear regression analysis of directly age-standardized rates for different types of primary care activity and primary care morbidity-specific contacts against Townsend and Index of Multiple Deprivation 2000 scores.


RESULTS
There were 44 per cent more out-of-hours contacts in more deprived areas (95 per cent confidence interval (CI) 17-70 per cent), 18 per cent more surgery consultations (95 per cent CI 8-27 per cent), and 28 per cent more same-day consultations (95 per cent CI 12-44 per cent). Routine visits by doctors and contacts by district and practice nurses did not have substantial associations with deprivation. Morbidity-specific contacts for psychological problems and respiratory problems were associated with deprivation but there was no significant association for contacts for low back pain, asthma or menopausal problems.


CONCLUSIONS
Different types of primary care activity and contacts for different morbidities had different associations with deprivation. This makes it difficult to recommend a simple list size adjustment; however, increased activity in deprived wards needs to be recognized in resource allocation, service configuration and performance management in primary care.
Carlisle
R
R
Sheffield Health Authority, Fulwood. robin.carlisle@sheffield-ha.nhs.uk
Avery
A J
AJ
Marsh
P
P
D000328:Adult; D000368:Aged; D004739:England; D005260:Female; D015276:Health Care Rationing / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D016014:Linear Models; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010348:Patient Care Team; D011203:Poverty; D011204:Poverty Areas; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011446:Prospective Studies; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom; D016526:Workload