Fairness in Primary Care Procurement Measures of Under-Doctoredness: Sensitivity Analysis and Trends

The White Paper Our Health, Our Care, Our Say noted concerns about geographical equity of access to GPs (Department of Health, 2006, page 63), listed the 30 PCTs with the lowest number of GPs per head of need adjusted population, and set out policy initiatives to attract additional providers of general practice services to these PCTs. We were asked to evaluate the impact of these policies on the bottom 30 PCTs and will report in Autumn 2010. In this report we consider a number of related measurement issues which are relevant for consideration of policy on equality of access to general practice. Our main conclusion is that whilst the set of worst provided PCTs varies, sometimes substantially, with the choice of GP supply measure, need adjustment, and population base, the set of 30 identified by the White Paper contains a core of around 10 PCTs which are amongst the worst provided on most possible alternative definitions. The White Paper set also contains a larger fringe group which are in the bottom 30 on some definitions, particularly when the White Paper definition of GPs is used, but which also often fall outside the worst provided bottom 30. There is no obviously right set of definitions of GPs, need adjustments, and populations which can be implemented with available data. Judgements are required and those underlying the White Paper seem not unreasonable. However, we suggest that consideration be given to broadening the definition of the general practice staff from GPs to include practice nurses and possibly non-clinical staff as well.