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GPs in affluent areas 'able to offer more time to complex patients'

Patients with multiple conditions who live in affluent areas get more time with a more attentive GP and feel their doctor has more empathy than patients in deprived areas, Scottish research suggests.

In a study of 659 consultations between 47 GPs and their patients, those in affluent areas with multiple chronic health problems got an average of three minutes longer at an appointment than other patients.

But in deprived areas, there was no difference in consultation length with patients getting around 10 minutes regardless of the complexity of their conditions.

Video analysis also showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multiple diseases than other patients.

This was not the case in deprived areas, the researchers from the University of Glasgow found.

And when patients in affluent areas with multiple conditions rated their GP as more empathic than those without did but this difference was not seen in deprived areas.

Writing in the Annals of Family Medicine (2018: 16 (2); 127-131), the researchers said action was needed to address the mismatch between need and service provision for patients with multimorbidity.

Co-author Professor Graham Watt, honorary senior research fellow at Glasgow University and founder of the Deep End project, said GPs in very deprived areas deal with more patients with premature multimorbidity complicated by social and financial issues but have no more funding per patient per year than the average and the new contract did not solve this problem.

‘They carry out about 20% more consultations but this is only possible either by having shorter average consultation times or working a longer day.

‘They work in a time poor setting. Both staff and patients are resigned to what is possible. Patient expectations and outcomes are lower. None of this new, but it is tolerated,’ he said.

Professor Watt explained that the new allocation formula tried to take into account workload but this did not capture unmet need and uncoordinated care.

He said: ‘There is no data-based formula that everyone will agree to.

‘A positive outcome would be to recognize that the contract is not a mechanism for developing needs-based services, and to find another way.’

He said Government-funded initiatives such as those in the Govan SHIP and Deep End practices which included putting young GPs into practices needed to continue long term but there was ‘very little confidence’ among those involved that this would happen.

 

Readers' comments (4)

  • Vinci Ho

    Oh , come on
    Julian (Tudor Hart) already had taught us with the Inverse Care Law and more resources (money , expertise, manpower and time simultaneously) are needed in these deprived areas.

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  • Come on guys - from watching videos??? Try seeing some patients and gain a bit of credibility.

    Could the GPs in affluent areas be better at playing the "academics" at their own game?

    Or do less able GPs gravitate to deprived areas?

    All questions worth asking.....

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  • Also are these the same Deep End GPs on the front of The Hearld recently with some of highest incomes in Scotland?

    Perhaps they should invest in staff rather than pocket as profit but still shout for more resources???

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  • 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.

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