GP postcode lottery harming patients, warns thinktank: GP surgeries in London and England's poorest areas offer the lowest-quality NHS care, King's Fund study shows
Londoners and people in deprived areas receive the lowest-quality care by GPs, according to research that has prompted fresh concern about postcode lotteries in NHS care.
A study by the influential King's Fund health thinktank found that family doctors' surgeries in London and England's poorest areas operate in the least patient-friendly ways and their patients experience the smallest improvements in their condition.
About half the weakest-performing practices (40%-60%) are in London and about 40% in the poorest areas, based on how they look after patients with conditions such as diabetes, high blood pressure and coronary heart disease, the researchers found.
Their analysis of NHS performance data at more than 8,000 surgeries across England reveals stark geographical inequalities in the quality of primary care. The conclusions came from examining which practices fared best and worst in delivering good healthcare under the NHS's quality outcomes framework and patient satisfaction ratings.
"With some exceptions, the high-performing practices are predominantly located outside London and in more affluent areas. In contrast, and again with some exceptions, practices that performed poorly on patient experience and clinical outcomes are predominantly located in London and in areas with higher deprivation," the study says.
The number of GPs is crucial to the quality of care overall provided by surgeries. The more GPs a surgery has, generally the better it performs, the researchers found. It also identifies single-handed GP practices, of which London has more than average, as problematic.
"Often they are operating out of smaller facilities and don't have such a wide range of staff or services for patients, such as a practice nurse or someone managing patient records and calling patients in for a review of their condition or medication at the right time", said Ana Dixon, King's Fund's director of policy.
Practices in which patients find it easy to get an appointment, usually get to see their own GP and have a say in their treatment also deliver the best outcomes for patients. Those features make patients more likely to comply with doctors' advice and also to take more responsibility for managing their condition, the study says.
More GPs needed to realise that ease and speed of access for the sick should be paramount because it helps improve patients' health and not simply because ministers want doctors to offer that, said Dixon.
Delays in seeing a GP could lead to late diagnosis of serious conditions such as cancer and also cost NHS money unnecessarily, because some patients unable to see a doctor at their local surgery would instead end up in A&E, which is more expensive, she warned.
Deprived areas might also have inferior GP services because practices there receive too little money to cope with more complicated patients, and might not be able to hire and retain the right staff, Dixon added.
The Department of Health said the findings were a worry. "This is concerning and provides clear evidence for why we are right to want to get to grips with health inequalities between deprived and better-off areas", said a spokeswoman.
"This is why we are proposing changes to the GP contract, so that the system is fairer, so that payments should better reflect the number of patients on GPs' lists and be appropriately weighted for factors such as age and deprivation."
The health secretary, new NHS commissioning board and GP-led clinical commissioning groups will also be under a legal duty from April to reduce health inequalities in access to services and outcomes of treatment, she added. The Guardian
Londoners and people in deprived areas receive the lowest-quality care by GPs, according to research that has prompted fresh concern about postcode lotteries in NHS care.
A study by the influential King's Fund health thinktank found that family doctors' surgeries in London and England's poorest areas operate in the least patient-friendly ways and their patients experience the smallest improvements in their condition.
About half the weakest-performing practices (40%-60%) are in London and about 40% in the poorest areas, based on how they look after patients with conditions such as diabetes, high blood pressure and coronary heart disease, the researchers found.
Their analysis of NHS performance data at more than 8,000 surgeries across England reveals stark geographical inequalities in the quality of primary care. The conclusions came from examining which practices fared best and worst in delivering good healthcare under the NHS's quality outcomes framework and patient satisfaction ratings.
"With some exceptions, the high-performing practices are predominantly located outside London and in more affluent areas. In contrast, and again with some exceptions, practices that performed poorly on patient experience and clinical outcomes are predominantly located in London and in areas with higher deprivation," the study says.
The number of GPs is crucial to the quality of care overall provided by surgeries. The more GPs a surgery has, generally the better it performs, the researchers found. It also identifies single-handed GP practices, of which London has more than average, as problematic.
"Often they are operating out of smaller facilities and don't have such a wide range of staff or services for patients, such as a practice nurse or someone managing patient records and calling patients in for a review of their condition or medication at the right time", said Ana Dixon, King's Fund's director of policy.
Practices in which patients find it easy to get an appointment, usually get to see their own GP and have a say in their treatment also deliver the best outcomes for patients. Those features make patients more likely to comply with doctors' advice and also to take more responsibility for managing their condition, the study says.
More GPs needed to realise that ease and speed of access for the sick should be paramount because it helps improve patients' health and not simply because ministers want doctors to offer that, said Dixon.
Delays in seeing a GP could lead to late diagnosis of serious conditions such as cancer and also cost NHS money unnecessarily, because some patients unable to see a doctor at their local surgery would instead end up in A&E, which is more expensive, she warned.
Deprived areas might also have inferior GP services because practices there receive too little money to cope with more complicated patients, and might not be able to hire and retain the right staff, Dixon added.
The Department of Health said the findings were a worry. "This is concerning and provides clear evidence for why we are right to want to get to grips with health inequalities between deprived and better-off areas", said a spokeswoman.
"This is why we are proposing changes to the GP contract, so that the system is fairer, so that payments should better reflect the number of patients on GPs' lists and be appropriately weighted for factors such as age and deprivation."
The health secretary, new NHS commissioning board and GP-led clinical commissioning groups will also be under a legal duty from April to reduce health inequalities in access to services and outcomes of treatment, she added. The Guardian
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