At the coalface
Dear Ian and others,
The study was not expensive. It used already published data from a variety of official sources and was done very quickly.
The central argument is that the decline of continuity is a consequence worsening access overall due to an imbalance between excessive workload and insufficient resources.
The authors were trying to highlight the pressures that primary care is under. It is obvious to those using or delivering the services, but not understood or acknowledged by those responsible for running it.
Raising awareness and stimulating debate are a start if things are to change.
Doubting Thomas does raise some important points and there are glaring examples to be found of practices earning large sums.
Pretty much everybody in primary care is struggling to do more with inadequate resources in an increasing difficult 'climate'. However, those working in the most deprived areas are finding it generally more difficult than elsewhere. 2 bits of evidence to back this up:
1. Whilst increasing age is probably the biggest predictor of illness, data from Tower Hamlets show that, on average, those aged 50 in the most deprived areas are consulting as much as those aged 70 in the most affluent areas.
2. After adjusting for population and organisational factors, practices working in the most deprived areas receive in total from the NHS about £3 more per patient on average than those working in affluent areas, but less enhanced service income (looking at all practices across England). This is scant compensation for the greater workload. There may be also less scope for these practices to top up with private work.
Overall, it is reasonable for those in Deep End projects to argue more resources.