A white paper on primary care was published yesterday (available fjdklfjdklfjdkljfdsklfjdsklfjdsfkljdsklfjdsklfjdsfkljdsfkldsjfkldsjfdklsjfdsklfjdsklfjdsklfjdskfldklsfjdkfljdfkjdfkljdfkjdsfkljdfkdjfkldjfkldsfjkldsfjdklsfjdkfjkfjdkfjdfkjdklfjdfkljdfkldjkldfjhere).
'GPs should be paid according to the needs of the patients they serve so they are encouraged to locate in deprived areas. More GPs in deprived areas and more community based healthcare, outside hospitals, is an effective way of reducing health inequalities. At present most GPs are paid a salary or are funded according to historical patterns, rather than on the basis of the health needs of their population.
'To make sure that choice works for disadvantaged groups and not just the healthier, the wealthier and the more demanding, the White Paper needs to commit resources to better information, advice and transport. Almost one and a half million people a year miss, turn down or do not seek healthcare because of lack of access to transport.
'With ever rising public expectations and pressure on NHS funding, a preventative approach that targets those at greatest risk and a debate about what the public can realistically expect from the NHS are the key challenges.'
IPPR's report recommends:
the introduction of 'support prescriptions' - help that is additional to medical treatment - so that GPs can target advice or advocacy for patients least able to negotiate their way around the NHS;
larger practice boundaries to encourage GPs to specialise, for example, in diabetes or older people's health and widen options for treatment outside hospitals;
budgets to enable patient groups and community and voluntary organisations to provide advice and support, for example Citizens Advice; and
more help with transport specifically aimed at the less mobile.
Equitable Choices for Health by Joe Farrington-Douglas and Jessica Allen is available here (executive summary).
IPPR has recently launched a project Great Expectations: towards a sustainable health system beyond 2008 - the research will focus on improving the nation's health, encouraging responsible use of the health system and ensuring fair and cost effective use of drugs and technology. For more details go to: www.ippr.org/health
Examples of health inequality:
Office of National Statistics figures on health inequalities in the UK show that Males born in Kensington and Chelsea have an average life expectancy at birth of 80.8 years compared to 72.3 years of those born in Manchester. Females born in Kensington and Chelsea have an average life expectancy of 85.8 years compared to 77.9 years of those born in Manchester.
Hip replacements were 20 per cent lower among lower socio economic groups, despite roughly a 30 per cent higher need.
A one-point move down a seven-point deprivation scale resulted in GPs spending 3.4 per cent less time with the individual concerned
Social classes IV and V had 10 per cent fewer preventative consultations than social classes I and II.