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GPs in deprived areas ‘need smaller caseloads’

GPs working in deprived areas need smaller caseloads to compensate for their far higher numbers of patients with multiple health problems, primary care experts have said after publication of a major new population study.

UK researchers found people in deprived areas had the same rates of multi-morbidity as more affluent people who were 10 to 15 years older.

Among patients aged 45 to 55, the rate of co-morbidity was twice as high among the most deprived patients as the least deprived, while a quarter of patients across the board had multiple health conditions.

The study, published by The Lancet last week, analysed data from 314 GP practices covering 1.7m registered patients in Scotland – about a third of the country's population.

Half the overall population had at least one illness by age 50 years, and in the 50-54 age group, 37% of the most deprived patients had multiple morbidities, compared with 18% of the least deprived.

Coronary heart disease, diabetes, COPD and cancer were all more common in deprived areas than more affluent ones, although there was a ‘small reverse gradient' for dementia and atrial fibrillation.

Study leader Professor Bruce Guthrie, professor of primary care medicine at the University of Dundee and a GP in the city, said: ‘Existing approaches focusing on patients with only one disease dominate most medical education, clinical research and hospital care, but increasingly need to be complemented by support for generalists, providing continuity, coordination and a personal approach for people with multimorbidity.'

‘This approach is most needed in socioeconomically deprived areas, where multimorbidity happens earlier, is more common and more frequently includes physical–mental health comorbidity.'

Professor Chris Salisbury, professor of primary health care at the University of Bristol and a GP in the city, wrote in an accompanying commentary that a redesign of general practice was needed: ‘Doctors working in deprived areas need smaller case loads because of the increased complexity of patients' medical needs. Instead of attending several disease-specific clinics, patients should have all of their chronic diseases reviewed in one visit by a clinician with responsibility for coordinating their care.'

Scottish health secretary Nicola Sturgeon said the study underlined that effective systems were needed in primary care to tackle health inequalities: ‘I look forward to further results coming from the research team, which is assessing a primary care-led approach as a mechanism for improving the quality of life of people with multimorbidity.'


Patients with multi-morbidity

Age group

Least deprived

Most deprived




















Source: Lancet 2012, online 10 May