Patients in the poorest areas are 63 per cent more likely than those in the richest locations to find it hard to see a GP. They are also 53 per cent more likely to attend accident and emergency, according to HSJ analysis of newly published figures.

Among those registered with practices in the poorest 10 per cent of areas, there was an average of 311 A&E attendances for every 1,000 patients during 2010. This was after weighting for factors of need including age and deprivation. Meanwhile, 31 per cent of patients registered with these practices had tried to see a GP quickly but were unable to do so within two working days.

In the richest 10 per cent there were 203 A&E attendances for every needs-adjusted 1,000 patients and just 19 per cent said they could not see a GP quickly.

The survey suggests a link between poorer patients finding it harder to see a GP and attending A&E instead. However, experts told HSJ the whole health and social care “system” was to blame.

Analysis shows that as deprivation levels increase, the number of patients generally being admitted to hospital as an emergency also increases, as does the cost of providing that care (see table below).

HSJ analysis shows that if spending on emergency admissions for the 40 per cent of practices with the most deprived population was reduced to the average, it would save about £104m. If the rate of A&E attendance for those practices was reduced to the average it would save a further £78m.

HSJ looked at GP practice level information published for the first time by the NHS Information Centre, under prime minister David Cameron’s “transparency” initiative.

Analysis also shows dramatic differences between rural and urban areas. Patients at practices in the most densely populated, urban areas are nearly twice as likely to attend A&E as those in the most sparsely populated “hamlets and isolated dwellings”.

The rate of emergency admissions in areas with the greatest population density is 89 per 1,000 – compared with 50 in the most sparse.

King’s Fund senior fellow Nick Goodwin, who wrote the think tank’s report on the quality of primary care earlier this year, said individual practices could not necessarily be blamed for high numbers of attendances and admissions. He said: “You are also talking about social care support, community care, and the ability of patients to recover.”

Although population figures have been adjusted to account for need for health services, that need and other population characteristics are likely to account for some variation.

But Mr Goodwin said practices located in difficult areas and demonstrating poor performance should take responsibility for shaping their own services.

He said the figures showed that in some areas “you are not getting the primary care co-ordination you want”.

He said: “You need to look at this and say, not ‘You’re a bad GP’, but, ‘Look at the situation you are in. You’re a single or two handed practice with a poor population, working every hour and doing your best, but you are working in a situation where you don’t have the necessary skills.’”

See larger map in separate window

GP practice map - performance and CCG


GP population deprivation, access and emergency care demand

Deprivation of GP practice population (measured by decile)Percentage of patients unable to see GP quickly*Number of GPs per 1,000 patientsA&E attendances per 1,000 patientsEmergency admissions per 1,000 patientsSpending on emergency admissions per 1,000 patients
(most deprived decile)
(least deprived decile)

NB All patient numbers refer to registered patients weighted according to needs

Data from GP patient survey