Are restrictive NHS contracts of benefit in addressing health inequalities? An ecological evaluation of their value in the North East of England.
OBJECTIVE
To determine if restrictive NHS contracts are of benefit in addressing health inequalities in oral health, by using an ecological approach based upon an area measure of material deprivation.


METHODS
Postcodes of patients seen under all the restrictive contracts (49) within the North East of England were identified and matched to lower super output areas. The deprivation scores were identified for each area using the Index of Multiple Deprivation 2007. The proportion of patients within each area was calculated and divided into deciles for England, from the most to the least deprived areas.


RESULTS
33,341 postcodes were identifiable from datasets supplied for the study in the North East; a further 4% were invalid. There was inequity in the distribution of patients, with proportionately more patients from the least deprived deciles and less patients from the more deprived deciles seen under the contracts. However, many thousands of patients identified lived in the most deprived areas.


CONCLUSIONS
Restrictive contracts may be of benefit in addressing health inequalities. PCTs need to carefully consider the impact of ending restrictive contracts on their local populations.
NHS County Durham and NHS Darlington, Public Health Team, John Snow House, Durham University Science Park, Durham, DH1 3YG. d.landes@nhs.net
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D000293:Adolescent; D002648:Child; D032982:Contracts; D019140:Dental Care for Children / Q000458:organization & administration; D004739:England; D006291:Health Policy; D006295:Health Resources / Q000600:supply & distribution*; D054624:Health Status Disparities; D006801:Humans; D011204:Poverty Areas; D011320:Primary Health Care / Q000458:organization & administration; D017062:Small-Area Analysis; D013218:State Dentistry / Q000458:organization & administration* / Q000706:statistics & numerical data; D017664:Uncompensated Care