A mounting cycle of pressures is having a disproportionate effect on GPs in the most deprived areas of England, increasing their workload as well as leading to growing inequality in provision for patients, the Health Foundation has warned. Not only are they looking after more patients than GPs in better-off areas, but their patients are also likely to experience worse health and multiple health conditions, further increasing workload.
The Health Foundation said full-time equivalent (FTE) GP numbers are falling across England at the same time as a growth in population, so the number of patients per qualified permanent GP has increased overall by 8% over three years, from 2,000 to 2,160. But the charity’s latest analysis* also revealed that patient numbers per GP are, on average, 15% higher in the most deprived 10% of clinical commissioning groups (CCGs) than in the least deprived 10% of CCGs – equivalent to about an extra 370 patients for each GP.
It explained that this already increased workload for GPs in deprived areas is further exacerbated because “those living in disadvantaged areas tend to experience worse health, are at greater risk of having multiple health conditions and more likely to have multiple conditions at a younger age”. Its own recent research has shown that in the least-deprived fifth of areas, people can expect to have at least two conditions by the time they are 71 years old – but in the most-deprived fifth, the average age at which this occurs is 61 years.
The Health Foundation noted: “Added to this, the number of FTE GPs is falling fastest in the most deprived areas, precisely the areas with the greatest health care need – government figures published last year showed that the GP workforce fell 50% faster in the most deprived areas in England than in the wealthiest over the past decade.”
Rebecca Fisher (Health Foundation policy fellow) and Ben Gershlick (senior economics analyst) pointed out that “despite a very public pledge in NHS England’s 2016 General Practice Forward View to recruit an additional 5,000 GPs by 2020, quite the reverse has happened”.
They said that NHS Digital’s April figures showing a 4% reduction in the number of FTE qualified permanent GPs between September 2015 and September 2018, meaning 1,180 fewer GPs, are concerning even at face value. But they said, “Bring deprivation and health need in to the picture, and the landscape becomes bleaker still… Even if all else were equal, more patients per GP means a higher workload for GPs working in deprived communities. But all is not equal and there's a multiplier effect.”
Fisher and Gershlick argued that the “pragmatic” proposals to increase by 20,000 the number of allied health professionals in primary care – such as physiotherapists, pharmacists and paramedics – might, if well implemented, alleviate some GP workload, but doesn’t solve the shortage of GPs. Furthermore, they said, there are no plans to ensure that this extra workforce will be evenly distributed across the country. They warned: “Without mechanisms to try to encourage or incentivise recruitment to areas of high deprivation, there’s a risk of perpetuating a cycle that could leave PCNs [primary care networks] serving the most deprived populations (with the greatest health needs) the least able to recruit.”
They concluded: “There's a commitment in the Long Term Plan for the NHS to play a greater role in reducing health inequalities. However, the inverse care law – that the availability of good medical care tends to vary inversely with the need for it in the population served – is alive and well in general practice.”
* Gershlick B, Fisher R. A worrying cycle of pressure for GPs in deprived areas. Health Foundation, published online 8 May 2019.