The continued “severe iniquity” in the geographical distribution of GPs threatens to place clinical commissioning groups in poor areas at a “large disadvantage”, MPs have been told.
A report by Manchester public health experts warns that CCGs in “under-doctored” areas will likely be provoked to “assertive” demands for the NHS Commissioning Board to redress the imbalance.
The analysis of GP distribution, submitted to a recent Commons health committee inquiry on workforce planning, found that sharp divides have persisted between rich and poor areas, and between the north and south.
At one extreme, it reported, the north west had just 52.5 whole time equivalent GPs per 100,000 weighted population – 12.8 per cent below the England average, or a shortfall of 620 GPs. At the other, London had 68.3 GPs per 100,000 – 13.5 per cent above average, or an “excess” of 573 GPs.
At PCT level, the iniquity was even more extreme – GP provision in the affluent London borough of Wandsworth was 53.4 per cent higher than average; in Nottingham city it was 43.8 per cent below average.
Under-provision was concentrated in areas with high health needs: the 10 PCT areas with the lowest concentration of GPs had standardised mortality ratios 28.3 per cent worse than the England average. The 10 with the highest GP concentrations had SMRs 12.2 per cent better than average.
The authors, from Manchester City Council and NHS Manchester’s joint public health research team, wrote: “The creation of CCGs brings the problem of GP distribution into sharper focus. Under-doctored CCGs and their patients will be starting at a large disadvantage and they will find it more difficult to absorb the new responsibilities for commissioning and budgeting.
“They will have little control over the situation because the GP budget will be under the control of the [NHS Commissioning Board].”
Under-doctored CCGs were “likely to be assertive in their demands for a fair share of GPs”.
These anticipated future problems made it important for the NHSCB to develop plans to address them now, they continued. Possible solutions, they suggested, might include:
- Providing start-up funding for new practices in under-doctored areas;
- Capping the list size each practice was allowed to maintain, to remove the financial incentive for GPs in under-doctored areas to build huge patient lists;
- Greater financial incentives for salaried GPs to work in poor health areas;
- Educating patients about the service standards they should expect from GPs, and the weighted list sizes of their local practices.