Researchers from the University of Glasgow have begun to explain how the NHS under-achieves in poor areas.


 In a study of general practices in the west of Scotland, they found that

- Patients in poor areas had a greater number of psychological problems;

- Patients in poor areas suffer from more long-term illness and larger numbers of different chronic health problems;

- Despite having more problems to discuss, consultations in deprived areas were generally shorter than in affluent areas;

- Doctors in deprived areas reported being under greater stress, especially after long consultations;

- For patients with psychological problems in deprived areas, the consultation with their GP was less helpful than it was for patients with psychological problems in affluent areas.

Graham Watt, professor of general practice and primary care, said: “This study shows the pressure that both patients and doctors are under.  

“The system is coping but it is not succeeding. Patients in deprived areas frequently have psychological problems in addition to their many medical problems. If patients cannot be helped satisfactorily with psychological problems, good medical care becomes much less likely.

“The NHS should be seen at its best in helping the neediest patients, but in this hallmark study that is not the case. Despite a decade of political rhetoric about addressing inequalities in heath care, the NHS has still not squared up to this problem.

“This is an important study as it is unusual to have good research evidence from the front line of the NHS in deprived areas.”

Dr Stewart Mercer of the Department of General Practice at Glasgow University led the study, published in the prestigious US journal, Annals of Family Medicine,  which compared more than 3000 patients and their doctors taking part in ordinary NHS consultations in typical general practices serving affluent and deprived populations.

Patients in poor areas had a greater number of psychological problems, more long-term illness and larger numbers of different chronic health problems. Despite having more problems to discuss, consultations in deprived areas were generally shorter than in affluent areas. Doctors in deprived areas reported being under greater stress, especially after long consultations. For patients with psychological problems in deprived areas, the consultation with their GP was less helpful than it was for patients with psychological problems in affluent areas.

The researchers conclude: “The increased burden of ill health and multi-morbidity in socio-economically deprived areas results in high demands on primary care and is associated with poorer access to care, less time spent with the doctor, higher GP stress, and lower patient enablement in encounters for psychosocial problems”.

Since the beginning of the NHS, the “Inverse Care Law” has described how the availability of good medical care tends to vary inversely with the need for it in the population served. Part of the explanation, highlighted by previous research by Professor Watt is the virtually flat distribution of general practitioners, with similar numbers serving all areas, irrespective of need.  There has been very little research, however, on how this affects patients and doctors in the day to day working of the NHS.

First published: 19 November 2007

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