Health Professions May 14, 2019
New analysis reveals mounting pressures on GPs in deprived areas

By News Feature - Accountable Care Journal

New analysis by the Health Foundation reveals a mounting cycle of pressures that are impacting disproportionately on GPs in the most deprived areas, increasing GP workload and leading to growing inequality in provision for patients.

Full-time equivalent (FTE) GP numbers are falling across England while the population continues to grow, meaning there are more and more patients per qualified permanent GP, rising from 2,000 to 2,160 – an increase of 8 per cent over three years.

While the number of patients per GP can vary by local area, the Health Foundation’s new analysis shows a worrying trend with patient numbers per GP 15 per cent higher in the most deprived 10 per cent of CCGs than in the least deprived 10 per cent. On average, a GP working in the most deprived areas can expect to be responsible for 370 more patients than a GP working in the least deprived.

The authors highlight that for GPs in deprived areas, the increased workload from higher patient numbers is exacerbated further as 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. Recent Health Foundation research found that in the least deprived fifth of areas, people can expect to have 2 or more conditions by the time they are 71 years old, but in the most deprived fifth, people reach the same level of illness a decade earlier, at 61 years of age.

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.

While current plans to increase the number of allied health professionals working alongside GPs are welcomed by the authors as a pragmatic way to alleviate some of this pressure, the new analysis shows that the number of pharmacists working in general practice is also lower in more deprived areas. On average, there are 8 per cent more patients per FTE pharmacist in the most deprived half of CCGs than in the least deprived half.

Projections from recent joint work with The King’s Fund and the Nuffield Trust suggest that without urgent policy action, if current trends hold, the number of GPs in England could continue to fall a further 4 per cent by 2023/24. Based on current population projections, this would increase the number of patients per GP by a further 7 per cent – a 15 per cent increase on numbers in 2015.

Ben Gershlick, a senior economist at The Health Foundation, said: "The vicious cycle of falling GP numbers driving increased workload is clear. Combine this with population growth and the picture is even more worrying.

"Our analysis shows that pressures on GPs are more pronounced in deprived areas, where health need is greatest and which are already losing GPs at a faster rate. To make good on the commitment in the NHS Long Term Plan to reducing health inequalities, a set of coherent actions are needed, focused on encouraging recruitment to areas of high deprivation. Without this, there’s a risk of further perpetuating this cycle."

Full analysis can be viewed here.