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GPs in deprived areas should work in ‘hubs’, concludes report

GPs in the most deprived areas of the country should be developed as ‘hubs’ for other services if health inequalities are to be tackled, conclude primary care researchers.

Their study of 100 Scottish general practices in deprived areas concluded that practices must ‘urgently’ increase the range of services they provide to help tackle the ‘inverse care law’.

It also called for additional clinical capacity, providing the pro rata equivalent of one extra GP session per week per 1,000 patients living in very deprived areas.

The ‘Deep End’ report warns that practices lack the time, links to other services, NHS support and leadership roles to prevent and reduce inequalities in health.

It says that the ‘the central and most urgent measure’ needed in order to address the inverse care law is to allow additional time for patient encounters.

However, the report warns: ‘Change cannot be achieved by Deep End practices on their own, nor can the situation be addressed by top down measures, with incomplete knowledge of local circumstances, or a lot of single projects each addressing only part of the problem.’

The researchers – led by Professor Graham Watt, professor of general practice and primary care at the University of Glasgow, proposes that there should be additional time for consultations with patients, including targeted appointments for those most in need.

It also recommends social care, mental health, addiction and child health specialists should be attached to general practices in a ‘hub’, and that a national enhanced service is created for practices to address the needs of vulnerable families.

It says: ‘The flat distribution of general practitioners in Scotland, in contrast to the steep social gradient of health needs, combined with often dysfunctional links between general practice and other parts of the NHS, are principal causes of the inverse care law in Scotland, providing not only a partial explanation of 20 years of failure in addressing inequalities in health, but also a major obstacle as NHS Scotland searches for effective, affordable ways of delivering integrated care for the increasing numbers of people with multiple health and health-related problems.’