The Government’s manifesto pledge to recruit 6,000 new GPs by 2024 could ‘widen’ inequities in access to care if the policy is not executed ‘with equity in mind’, a thinktank has said.
It urged the Government to make ‘key’ changes to GP funding and to how equitably the workforce is distributed to support ‘under-doctored’ areas of England.
In a new report (27 January), the Health Foundation assessed how to reverse the ‘inverse care law’: a term coined by a GP 50 years ago to describe how people who most need health care are least likely to receive it.
The researchers said the phenomenon ‘persists in the NHS today’, said the report, with GP practices in more deprived areas of England ‘relatively underfunded, under-doctored, and perform less well on a range of quality indicators’ compared to those in wealthier areas.
‘Yet current policies on general practice in England risk exacerbating inequities because they are not designed with the inverse care law in mind,’ the Health Foundation said.
‘For example, if the extra 6,000 GPs promised by Government work in wealthier areas, inequities in access to care will widen.’
It comes after the health secretary admitted the Government will fail to fulfil the election pledge by the 2024 deadline it set.
Workforce strategy must address equity
A medium and long-term workforce strategy should be drafted up which ‘considers mechanisms to more equitably distribute’ the GP workforce, the report said.
As part of this strategy, the Government should consider ‘stronger central coordination and oversight’ of GP distribution.
The recommendation is based on analysis of 30 years of policy efforts to reduce inequities in the provision of GP services, which the Health Foundation claimed ‘have not been enough to overcome them’ and are often ‘small in comparison with the scale of the problem’.
To reduce inequities, policymakers should:
- Make addressing inequities a national priority
- Subject new GP policies to an ‘equity test’
- Examine alternative approaches to allocating funding resources
- Develop a medium and long-term workforce strategy
- Introduce a requirement for integrated care boards (ICBs) to develop plans to reduce inequities
- Ensure the Government commits to more rigorous evaluation of policies affecting general practice
Similarly, new policies for general practice in England should be subject to an ‘equity test’ to consider how the policy may impact on the equitable provision of general practice.
It also suggested the Government establish an independent review of general practice funding allocations to determine how income streams differ by level of deprivation.
Addressing the inverse care law in general practice should also become ‘an explicit national priority’ and a ‘core’ part of the Government’s levelling up agenda, it said.
It said: ‘Without deliberate policy action, inequities in general practice in England are likely to grow.’
A recent study indicated that the most deprived areas in England had almost one and a half fewer FTE GPs (1.41) per 10,000 patients than the least derived areas.
