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The waiting game

Salaried GP drive fails to ease health inequalities

The growing rift in the profession between partners and salaried GPs does not appear to have come with the predicted benefits for recruiting to hard-to-reach areas, a new study suggests.

Researchers found no evidence that the Government's drive to encourage employment of salaried GPs had had any benefits for deprived areas, with salaried posts most often created in affluent areas instead.

The study, published in this month's British Journal of General Practice, found PMS practices had been particularly proactive in recruiting salaried GPs, with some evidence that their recruitment had helped increase practices' QOF scores.

The research, conducted by the National Primary Care Research and Development Centre, used GP census data from the Information Centre to assess claims that salaried posts were targeted at under-served areas and would help the Government reduce inequalities in GP distribution.

Using QMAS data, the study compared deprivation scores among practices with and without a salaried GP – with a higher value score representing a more deprived community.

Practices with salaried posts were generally found to be in slightly more affluent areas, with a median deprivation score of 17.75, compared with 23.10 for those practices with principals only. The study also found that QOF scores were slightly higher for practices with salaried posts.

The research also found that salaried GPs were more mobile than partners, and were typically younger (under 35 years), older (over 65), female or overseas qualified, and favoured part-time working and PMS contracts.

Study leader Professor Bonnie Sibbald said that the increased prevalence of PMS contracts, which were initially introduced at the same time as salaried positions in order to target deprived areas, had led to salaried positions increasingly being located in more affluent neighbourhoods.

She said: ‘Salaried GPs were conceived as one way of reducing inequality, but it's clear that they cannot do that as they're no longer a benefit of working only in deprived areas. There has to be an additional benefit to offset the obvious disadvantages of being there. We need either much bigger monetary incentives or non-pay benefits, for example, more investment in larger and better practices with more facilities.'

Dr Richard Fieldhouse, vice-chair of the National Association of Sessional GPs and a locum in Portsmouth, said it was understandable that salaried GPs want to work in affluent areas, and urged the Government to look to locum groups to reduce GP inequalities.

He said: ‘In some of these inner city practices we're practically the only doctors there, and we provide a really good high quality service, with fantastic feedback from patients. That's something that the Government hasn't yet picked up on it's radar.'

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