Unequal socioeconomic distribution of the primary care workforce: Whole-population small area longitudinal study

BMJ Open

Volumn 6, Issue 1, 2016, Pages

  Asaria, Miqdad ^a   Cookson, Richard ^a   Fleetcroft, Robert ^b   Ali, Shehzad ^a  

^a UNIVERSITY OF YORK   (United Kingdom)

^b UNIVERSITY OF EAST ANGLIA   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

CLINICAL ARTICLE; GENERAL PRACTITIONER; HUMAN; INVESTMENT; LICENCE; LONGITUDINAL STUDY; NEIGHBORHOOD; PRIMARY MEDICAL CARE; UNITED KINGDOM; ENGLAND; HEALTH CARE DISPARITY; HEALTH CARE MANPOWER; MANPOWER; PRIMARY HEALTH CARE; SMALL-AREA ANALYSIS; SOCIOECONOMICS; STATISTICS AND NUMERICAL DATA; SUPPLY AND DISTRIBUTION; TRENDS;

ENGLAND; GENERAL PRACTITIONERS; HEALTH MANPOWER; HEALTHCARE DISPARITIES; HUMANS; LONGITUDINAL STUDIES; PRIMARY HEALTH CARE; SMALL-AREA ANALYSIS; SOCIOECONOMIC FACTORS;

EID: 84960350660     PISSN: None     EISSN: 20446055     Source Type: Journal    
DOI: 10.1136/bmjopen-2015-008783     Document Type: Article

References (44)

1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83:457-502.
2. Newhouse JP, Williams AP, Bennett BW, et al. Does the geographical distribution of physicians reflect market failure? Bell J Econ 1982;13:493-505.
3. Marmot M, Friel S, Bell R, et al. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008;372:1661-9.
4. Baker M, Ware J, Morgan K. Time to put patients first by investing in general practice. Br J Gen Pract 2014;64:268-9.
5. Iacobucci G. Increase general practice funding or risk "death of the family doctor," GP leader warns BMJ2015;350:h859.
6. Bodenheimer TS, Smith MD. Primary care: proposed solutions to the physician shortage without training more physicians. Health Aff (Millwood) 2013;32:1881-6.
7. Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012;380:37-43.
8. Department of Health. Long Term Conditions Compendium of Information. 2012. https://www.gov.uk/government/uploads/system/uploads/attachment-data/file/216528/dh-134486.pdf (accessed 05 Nov 14).
9. Charlton J, Rudisill C, Bhattarai N, et al Impact of deprivation on occurrence, outcomes and health care costs of people with multiple morbidity. J Health Serv Res Policy 2013;18:215-23.
10. Baker M. Strategic Review of Health Inequalities in England Post 2010 (Marmot Review). 2009. http://www.rcgp.org.uk/Policy/RCGP-policy-areas/~/media/Files/Policy/A-Z-policy/RCGP-Marmot-Review-Paper-September-2008.ashx (accessed 3 Nov 14).
11. Department of Health. Equity and excellence: liberating the NHS. Department of Health, ed. London: The Stationary Office, 2010. https://www.gov.uk/government/uploads/system/uploads/attachment- data/file/213823/dh-117794.pdf).
12. Royal College of General Practitioners. Over 500 surgeries at risk of closure as GP workforce crisis deepens. 2014. http://www.rcgp.org. uk/news/2014/october/over-500-surgeries-at-risk-of-closure-as-gp-workforce-crisis-deepens.aspx (accessed 6 Nov 14).
13. Kaffash J. Revealed: 15% drop in GP training applications set to exacerbate recruitment crisis. PULSE. 2014. http://www.pulsetoday. co.uk/your-practice/practice-topics/education/revealed-15-drop-in-gp-training-applications-set-to-exacerbate-recruitment-crisis/20005739. article#.VIXTUdJybcs (accessed 5 Feb 2014).
14. Yardim M, Uner S. Geographical disparities in the distribution of physicians in Turkey. TAF Prev Med Bull 2013;12:487-94.
15. Matsumoto M, Inoue K, Farmer J, et al. Geographic distribution of primary care physicians in Japan and Britain. Health Place 2010;16:164-6.
16. Petterson SM, Phillips RL Jr, Bazemore AW, Koinis GT Unequal distribution of the US primary care workforce. Am Fam Physician 2013;87;11, pp. Online-Online. http://www.aafp.org/afp/2013/0601/od1.pdf
17. Hann M, Gravelle H. The maldistribution of general practitioners in England and Wales: 1974-2003. Br Gen Pract 2004;54:894-8.
18. Isabel C, Paula V. Geographic distribution of physicians in Portugal. Eur J Health Econ 2010; 11:383-93.
19. Fülöp G, Kopetsch T, Hofstätter G, et al. Regional distribution effects of 'needs planning' for office-based physicians in Germany and Austria-methods and empirical findings. J Public Health 2008;16:447-55.
20. Brown M. Using Gini-style indices to evaluate the spatial patterns of health practitioners: Theoretical considerations and an application based on Alberta data. Soc Sci Med 1994;38:1243-56.
21. Stapleton G, Schröder-Bäck P, Brand H, et al. Health inequalities and regional specific scarcity in primary care physicians: ethical issues and criteria. Int J Public Health 2014;59:449-55.
22. Gravelle H, Sutton M. Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995. J Health Serv Res Policy 2001;6:6-13.
23. Goddard M, Gravelle H, Hole A, et al. Where did all the GPs go? Increasing supply and geographical equity in England and Scotland. J Health Serv Res Policy 2010;15:28-35.
24. Centre for Workforce Intelligence. GP in-depth review; Preliminary Findings. 2013. http://www.cfwi.org.uk/publications/gp-in-depth-review-preliminary-findings/@@publication-detail (accessed 5 Nov 14).
25. Sibbald B. Putting general practitioners where they are needed: an overview of strategies to correct maldistribution. Secondary Putting general practitioners where they are needed: an overview of strategies to correct maldistribution. 2005. http://www.population-health.manchester.ac.uk/primarycare/npcrdc-archive/archive/PublicationDetail.cfm/ID/139.htm
26. Hutt P, Gilmour S. Tackling inequalities in general practice. 2010 7 September 2010. http://www.kingsfund.org.uk/sites/files/kf/field/field- document/health-inequalities-general-practice-gp-inquiry-research-paper-mar11.pdf (accessed 5 Mar 2015).
27. Department of Health. Our Health, Our Care, Our Say. 2006. https://www.gov.uk/government/uploads/system/uploads/attachment-data/file/272238/6737.pdf (accessed 6 Nov 14).
28. Department of Health. Equitable Access to Primary Medical Care services. 2007. http://webarchive.nationalarchives.gov.uk/+/www.dh. gov.uk/en/Aboutus/Procurementandproposals/Procurement/ProcurementatPCTs/index.htm (accessed 08 Dec 2014).
29. Goldhill F, Alexander B. GP training practices £100 m capital programme guidance. Secondary GP training practices £100 m capital programme guidance. 2009. http://webarchive. nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en//Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH-098860
30. Hakin B. Equitable Access Programme: Primary Medical Care Services (letter). 2011. 3 February 2011; (2 February 2015). https://www.gov.uk/government/uploads/system/uploads/attachment-data/file/215793//dh-123926.pdf (accessed 2 Feb 2015).
31. The GP Taskforce. Securing the Future GP Workforce: Delivering the Mandate on GP Expansion. 2014. 18 July 2014. http://hee.nhs. uk/wp-content/uploads/sites/321/2014/07/GP-Taskforce-report.pdf (accessed 18 Dec 2014).
32. McNeil F. Making the most of a part time GP registrar post. BMJ Careers. 2007. 18 August 2007. http://careerfocus.bmj.com/cgi/content/full/335/7615/gp63-a (accessed 18 Dec 2014).
33. The Information Centre for Health and Social Care. General and Personal Medical Services England 2002-2012. Leeds, 2013. http://www.hscic.gov.uk/catalogue/PUB09536/nhs-staf-2002-2012-gene-prac-rep.pdf.
34. British Medical Association. Model GP retainer scheme contract. 2005. http://bma.org.uk/practical-support-at-work/contracts/sessional-gps (accessed 2 Feb 2015).
35. Formula Review Group. Review of the General Medical Services global sum formula. London: NHS Employers and BMA, 2007.
36. NHS England Strategic Finance. Technical Guide to the formulae for 2014-15 and 2015-16 revenue allocations to Clinical Commissioning Groups and Area Teams. 2014. 25 March 2014. http://www.england.nhs.uk/2014/03/27/allocations-tech-guide/(accessed 11 Feb 2015).
37. WIRED GOV LTD. New practices for under-doctored areas. 2007. 23 November 2007. http://www.wired-gov.net/wg/wg-news-1.nsf/0/4EEF1F44D83DBD5D8025739C003E7DE8?OpenDocument (accessed 2 Feb 2015).
38. Hippisley-Cox J, Coupland C, Pringle M, et al. GMS formula review analysis of the QRESEARCH database. Final Report to the GMS Review Group. 10 February 2006 Nottingham: NHS Employers, 2006.
39. Roberts N. GMS Funding Changes [letter]. 2014. 12 August 2014. http://www.google.co.uk/url?sa=t&rct=j&q=& esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCEQFjAA& url=http%3A%2F%2Fbma.org.uk%2F-%2Fmedia%2Ffiles%2Fpdfs% 2Fworking%2520for%2520change%2Fnegotiating%2520for% 2520the%2520profession%2Fgeneral%2520practitioners%2Fgms% 2520changes%2520lmc%2520letter%252012-8.pdf& ei=K97YVKr8NY7datOPgOgL&usg=AFQjCNEca2rjaBdxpuL dEr9cVHnf416rTA (accessed 9 Feb 2014).
40. Dilonot A. Statistics on general practitioners [letter]. London, 2014. Annex A, footnote 3. http://www.statisticsauthority.gov.uk/reports- correspondence/correspondence/letter-from-sir-andrew-dilnot-to-rt-hon-andy-burnham-mp-201114.pdf
41. Poulter D. Response to parlimentary question from Luciana Berger; To ask the Secretary of State for Health how many general practitioners (a) excluding retainers and registrars, (b) including retainers but excluding registrars there were in (i) 2009-10 and (ii) 2013-14. Department of Health, ed. London: House of Commons., 2014. http://www.publications.parliament.uk/pa/cm201415/cmhansrd/cm140715/text/140715w0003.htm.
42. GP workforce crisis hits record level. PULSE. 19 October 2003. London: Cogora Ltd, 2003. http://www.pulsetoday.co.uk/gp-workforce-crisis-hits-record-level/10865868.article.
43. Hutt PGS. Tackling inequalities in general practice. 2010 07 September 2010. Tackling inequalities in general practice. (accurl=http%3A%2F%2Fbma.org.uk%2F-%2Fmedia%2Ffiles%2Fpdfs%2Fworking%2520for%2520change%2Fnegotiating%2520for%2520the%2520profession%2Fgeneral%2520practitioners%2Fgms%2520changes%2520lmc%2520letter%252012-8.pdf&ei=K97YVKr8NY7datOPgOgL&usg=AFQjCNEca2rjaBdxpuLdEr9cVHnf416rTAessed 5 Mar 2015).
44. Kaffash J. Almost 40% of GP training places are unfilled in some areas of the UK. PULSE. 2014. http://www.pulsetoday.co.uk/your-practice/practice-topics/education/almost-40-of-gp-training-places-unfilled-in-some-areas-of-uk/20006989.article#.VJLRtNJybcs