title: Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort.
abstract: The 'Five Year Forward View' (NHS England) calls for a radical upgrade in public health provision. Inequalities in maternal health may perpetuate general patterns of health inequalities across generations; therefore equitable access to general practice (GP) provision during maternity is important. This paper explores variation in GP consultation rates for disadvantaged mothers.
  
  
  
  Data from the Born in Bradford cohort (around 12 000 women), combined with GP records and GP practice variables, were modelled to predict GP consultation rates, before and after adjusting for individual health and GP provision.
  
  
  
  Observed GP consultation rates are higher for women in materially deprived neighbourhoods and Pakistani women. However these groups were found to consult less often after controlling for individual health. This difference, around one appointment per year, is 'explained' by the nature of GP provision. Women in practices with a low GP to patient ratio had around 09 fewer consultations over the six year period compared to women in practices with the highest ratio.
  
  
  
  Equitable access to GP services, particularly for women during the maternal period, is essential for tackling deep-rooted health inequalities. Future GP funding should take account of neighbourhood material deprivation to focus resources on areas of the greatest need.
authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, BradfordBD9 6RJ UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Kelly
authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, BradfordBD9 6RJ UK.
authors.forename: Dan
authors.initials: D
authors.lastname: Mason
authors.affiliation: School of Sport, Exercise and Health Sciences, Loughborough University, LeicestershireLE11 3TU UK.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Petherick
authors.affiliation: Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, BradfordBD9 6RJ UK.
authors.forename: John
authors.initials: J
authors.lastname: Wright
authors.affiliation: Healthcare Quality and Effectiveness, Faculty of Health Studies, University of Bradford, BradfordBD7 1DP UK.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Mohammed
authors.affiliation: Data and Analytics Informatics & Research, TPP, Mill House, Troy Road, LeedsLS18 5TN UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Bates
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004739:England; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000458:organization & administration* / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D009035:Mothers / Q000706:statistics & numerical data*; D013222:State Medicine / Q000458:organization & administration / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Ethnicity; Primary care; Public health