A new report published in the British Medical Journal (BMJ) today suggests that the NHS needs to do more to provide health care according to need, by analysing the availability of primary care according to deprivation and health needs in Scotland.

The study was based as part of the Platform Project, based at the University of Glasgow and in collaboration with partners at the Universities of Edinburgh, Dundee, Aberdeen and the Scottish School of Primary Care.

Research findings were based on the total population of the 5.35 million people living in Scotland served by 1, 050 general practices and divided into ten groups of equal size according to deprivation.

The results show that ill health is two and a half times greater in the most deprived group compared to the most affluent, but the number of whole time equivalent GP principals is distributed evenly across the population.

However, including non-principals and doctors in training, there are 11% more GPs in the more affluent compared with the more deprived half of the population. 83% of the practices serving the most deprived tenth of the Scottish population are based in Greater Glasgow.

Professor Graham Watt from the University of Glasgow explains:

'The general practices serving the most deprived 10% of the Scottish population, comprising over half a million people, are the front line of the NHS in Scotland. Surely that is where the NHS should be seen at its best, with the best examples of quality services, and the most attractive career opportunities. But the opposite is the case."

"Despite two and a half times the health need, the poorest 10% of the population has the same number of GPs as the most affluent 10% of the population. Quality schemes, service initiatives, research and training are all twice as common in more affluent areas. Too many NHS agencies and organisations have policies which fizzle out in the last third of the population.'

Although they found larger numbers of practices in the most rural and deprived areas, this reflects the higher proportion of single-handed and small run practices. In fact, they show that practices in deprived areas tend to have younger doctors, fewer female doctors, and less involvement in voluntary activities such as quality schemes, health service initiatives, and training than practices serving more affluent areas.

Practices serving the most deprived areas are less likely to volunteer because they are so consumed by dealing with increased levels of morbidity, without increased levels of medical manpower, that they are unable or unwilling to take on additional activities. The greatest challenge facing any national health service aiming for the equitable delivery of high quality care is to develop the best examples of care and the most attractive professional career opportunities in populations where need is greatest. The report concludes that the NHS has much more to do in tackling this challenge.

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First published: 15 December 2005