The maldistribution of general practitioners in England and Wales: 1974-2003.
BACKGROUND
The geographical distribution of general practitioners (GPs) is a persistent policy concern within the National Health Service. Maldistribution across family health service authorities in England and Wales fell between 1974 and the mid-1980s but then remained, at best, constant until the mid-1990s.


OBJECTIVE
To estimate levels of maldistribution over the period 1994-2003 and to examine the long-term trend in maldistribution from 1974-2003.


METHODS
Annual snapshots from the GP census.


METHODS
One hundred 2001 'frozen' health authorities in England and Wales for 1994-2003 and 98 family health service authorities for 1974-1995.


METHODS
Ratios of GPs to raw and need-adjusted populations were calculated for each health authority for each year using four methods of need adjustment: age-related capitation payments, national age- and sex-specific consultation rates, national age- and sex-specific limiting long-term illness rates, and health authority-specific mortality. Three summary measures of maldistribution across health authorities in the GP to population ratio--the decile ratio, the Gini coefficient, and the Atkinson index--were calculated for each year.


RESULTS
Maldistribution of GPs as measured by the Gini coefficient and Atkinson index increased from the mid-1980s to 2003, but the decile ratio showed little change over the entire 1974-2003 period. Unrestricted GP principals and equivalents were more equitably distributed than other types of GP.


CONCLUSIONS
The 20% increase in the number of unrestricted GPs between 1985 and 2003 did not lead to a more equal distribution.
Hann
Mark
M
National Primary Care Research and Development Centre, University of Manchester, Manchester. mark.hann@manchester.ac.uk
Gravelle
Hugh
H
D003710:Demography; D004739:England; D006801:Humans; D020380:Needs Assessment; D010821:Physicians, Family / Q000600:supply & distribution* / Q000639:trends; D011365:Professional Practice Location / Q000706:statistics & numerical data / Q000639:trends; D014852:Wales