General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland

McLean, G., Guthrie, B., Mercer, S.W. and Watt, G.C.M. (2015) General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland. British Journal of General Practice, 65(641), e799-e805. (doi:10.3399/bjgp15X687829)

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Abstract

Background Universal access to health care, as provided in the NHS, does not ensure that patients’ needs are met. Aim To explore the relationships between multimorbidity, general practice funding, and workload by deprivation in a national healthcare system. Design and setting Cross-sectional study using routine data from 956 general practices in Scotland. Method Estimated numbers of patients with multimorbidity, estimated numbers of consultations per 1000 patients, and payments to practices per patient are presented and analysed by deprivation decile at practice level. Results Levels of multimorbidity rose with practice deprivation. Practices in the most deprived decile had 38% more patients with multimorbidity compared with the least deprived (222.8 per 1000 patients versus 161.1; P<0.001) and over 120% more patients with combined mental–physical multimorbidity (113.0 per 1000 patients versus 51.5; P<0.001). Practices in the most deprived decile had 20% more consultations per annum compared with the least deprived (4616 versus 3846, P<0.001). There was no association between total practice funding and deprivation (Spearman ρ −0.09; P = 0.03). Although consultation rates increased with deprivation, the social gradients in multimorbidity were much steeper. There was no association between consultation rates and levels of funding. Conclusion No evidence was found that general practice funding matches clinical need, as estimated by different definitions of multimorbidity. Consultation rates provide only a partial estimate of the work involved in addressing clinical needs and are poorly related to the prevalence of multimorbidity. In these circumstances, general practice is unlikely to mitigate health inequalities and may increase them.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McLean, Dr Gary and Watt, Professor Graham and Mercer, Professor Stewart
Authors: McLean, G., Guthrie, B., Mercer, S.W., and Watt, G.C.M.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
Journal Name:British Journal of General Practice
Publisher:Royal College of General Practitioners
ISSN:0960-1643
ISSN (Online):1478-5242
Copyright Holders:Copyright © 2015 British Journal of General Practice
First Published:First published in British Journal of General Practice 65(641):e799-e805
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
477971Living Well with Multiple MorbidityStewart MercerScottish Executive Health Department (SEHHD-CSO)ARPG/07/01IHW - GENERAL PRACTICE & PRIMARY CARE