General practice potentially has a key role in addressing the big disparities in health and life expectancy still found across sections of the population. Therefore we should ask whether the same level of quality of care is provided by general practices to all members and sub-groups of a practice population, or whether some types of patient are treated differently.
Related document: Tackling inequalities in general practice
What did we explore?
To inform its work, the Inquiry panel commissioned a research project to examine whether there are hidden inequalities in access or treatment, and how this might be measured. The project also assessed the role of general practice in reducing inequalities in their local community. Tackling inequalities in general practice explores evidence of different patient experiences, for example, by class, age, gender or type of condition. The paper's lead authors are Patrick Hutt, GP and Clinical Associate, Department of Primary Care and Population Health, UCL, and Stuart Gillmore, Research Fellow, The King's Fund.
What have we learnt about GPs and inequalities?
In March 2010 the Inquiry held a seminar on inequalities with participants including GPs, practice nurses, NHS executives, health academics and patient representatives.
Key issues raised in discussion include:
- What measures would enable general practice to be more proactive in identifying population sub-groups who are not seeking care or not being referred?
- How can primary care trusts facilitate greater interaction between general practice and other public services for a more 'holistic' approach to reducing health inequalities?
- Are child health and prevention the key to addressing inequalities?
What's your view?
Although nursing is mentioned in the study it is disappointing that its contribution seems to be largely described as a means to "free up time for GPs". Nursing is uniquely placed to compliment General Practice in that its approach is holistic and person centred, nursing values respect that health is both a process and a state. The report rightly comments that GPs have traditionally not been well prepared in areas of health promotion, whereas nursing always looks beyond the presenting problem towards promotion of independence, choice and wellbeing. I would suggest that GP Practices with nursing partnership and development of services to work alongside people with long term conditions do much to foster self-care, choice and health in their areas. GP commissioning, with nursing partnership and a multidisciplinary approach has the potential to make a significant difference to the expectations of users contracting to use the services of the practice and the customer care they receive as a result which would emphasize education, choice, dignity, independence and responsibility in planning alongside the treatment.
Thanks so much for a thought-provoking paper. I enjoyed it. I was particularly interested in the recommendations of "social prescribing". On the back of your and Marmot's recommendation we are going to try to improve this area in Hackney by getting GP trainees involved. The VTS group have certainly warmed to it as have senior Hackney GPs. The VTS plan to research certain areas and services locally (as they work all over Hackney) and then we plan to pool our knowledge. The need to address the social dimension and determinants are readily recognised by GPs junior and senior alike. I was wondering whether you could expand further on what you felt "social prescribing" and perhaps "social pathways" would look like, how we could establish it systemically and how it might function. You also mention the need to evaluate interventions in this field to judge their impact. How do you or should we plan to do that? The Hackney VTS and I would be most grateful for your insights!
We are currently engaged in research to find out what is happening by identifying every person in the 4 most and the 4 least deprived neighbourhoods by postcode (in whatever practice they are registered) and directly comparing detection and effective treatment rates between the two cohorts. we hope to publish our results in 2011.
This paper will be very helpful for the next phase - what to do about any differences that we find!