Dr Mike Warburton National Director for the National GP Access Programme Department of Health

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Health Inequalities and GP Access
Dr Mike WarburtonNational Director for the
National GP AccessProgrammeDepartment of Health
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Context
NHS Reform
Expanding capacity increasing
investment Waiting times- 18 weeks
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Shifting the power
Introduction of radical changes Patient Choice,
PBR, PBC
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Focus on quality outcomes and patient
experience Health Inequalities and health
outcomes, Quality
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GP Access and Inequalities

• UK data shows better outcomes linked to more GPs
  per head of Population
• US evidence
• Access to freely chosen GP is assoc with better
  and more appropriate care and better health at
  lower cost- Barbara Starfield
• Where patients have a primary care physician
  they achieve a lower 5yr mortality rate
• High quality primary care associated with reduced
  racial and ethnic disparities

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Inequalities and deprivation
Case for change
Two-fold gap remains across the country between
numbers of GPs and nurses

• Those areas with fewer primary care clinicians
  also tend to have
• Poorer health outcomes
• Lower QOF scores
• Closed lists
• Fewer GP registrars
• An ageing GP population

Cambridgeshire has almost 60 WTE GPs and
nurses/100k population more than Manchester and
the average man can expect to live 6 years longer
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Patient satisfaction
Case for change
GP Patient Survey overall shows good progress
84 of patients satisfied with access to GP
services

• However
• BME patients less satisfied (Bangladeshi patients
  20 less happy than white patients, sometimes
  even within the same practice)

• 6.5 million patients unhappy with practice
  opening times
• Younger employed people unhappy with current
  opening hours
• Large variation between practices within PCTs

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Patient Satisfaction Inequalities

• Practices in deprived areas perform worse than
  practices in affluent areas
• Worst performing practices are large practices in
  deprived areas serving a significant black and
  ethnic minority population

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What happened as a result of the GPPS?

• Alan Johnson announced 5 measures for local
  action to improve access to primary care
• Local PCT action plans
• Publication of practice performance data (GPPS
  QOF) on NHS choices to empower patients
• Establishment of the National Improvement Team to
  support poorly performing PCTs and practices to
  improve access
• Mayur Lakhanis review of BME access to primary
  medical care
• Review of the incentives for access and
  responsiveness in QOF
• National GP Access Programme (March 2008)

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National GP Access Programme

• Drivers
• Improving health inequalities
• Increasing patient satisfaction

1. Extending hours of existing practices
2. Local procurements of GP practices and health
centres
3. Wider responsiveness to patient needs
50 of practices to open at times that suit the
needs of their patients

• Additional 250m for
• 100 new GP practices in areas of greatest need
• 152 GP-led health centres

Continuing improvements in the access and
responsiveness of GP services (building on the
recommendations in the BME and NIT reports)
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Support
National GP Access Programme
1. Extending hours of existing practices
2. Local procurements of GP practices and health
centres
3. Wider responsiveness to patient needs

• Regional workshops run by NHS PCC to support
  implementation of the extended hours DES.
• DH will support NHS PCC with a peer support
  process to collectively work through barriers to
  progress, highlight and share best practice
  nationally and answer FAQs as they arise.

• Combined approach of strengthening PCT
  commissioning and developing primary care
  providers
• Currently discussing with SHAs/PCTs and providers
  the most appropriate approaches but this will
  include as a starting point, collating and
  systematically sharing existing best practice

• Support package comprising
• Procurement Framework
• SHA embedded commercial expertise through
  Commercial Partnership Managers and PASA
  Commercial Development Managers
• DH mailbox for queries
• Regional procurement master classes
• Support for regional bidder information days
• PCC expert technical support

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Local needs

• North Yorkshire and York PCT -highest rates in
  England for under 18 alcohol specific hospital
  admissions and are procuring a range of
  additional services targeted at the younger
  population including sexual health and drug
  alcohol services, mental health and homeless
  services.
• Kirklee's plan to locate their health centre in
  an area with high list sizes where patients are
  finding it difficult to register.
• Bolton PCT are incorporating a special interest
  practitioner service within their health centre
  focussing on the induction and integration of
  asylum seekers, refugees and economic migrants.
• Bradford plan to locate the health centre in
  their most deprived ward with high rate of
  unemployment, overcrowded housing and a growing
  Eastern European transient population. They plan
  to procure additional language services within
  the centre to improve access for BME groups.

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Looking Ahead

• Inequalities in service provision need to be
  addressed- we have made a start
• Questions
• Do we need more of the same or different models
  of primary care to address different needs?
• As well as achieving universally excellent GP
  access is Health Literacy the next step in
  ensuring primary care is as effective as possible
  in reducing health inequalities
• In improving access generally without a specific
  focus on inequality, we risk widening the health
  inequality gap ..Further work needed

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Any further support required?
National Support Team Dr Mike Warburton
Mike.warburton_at_dh.gsi.gov.uk Phil
Walker Philip.walker_at_dh.gsi.gov.uk Andrew
Kent Andrew.kent_at_dh.gsi.gov.uk Dean
Merritt Dean.merrett_at_dh.gsi.gov.uk Kathryn
Stillman-Burrell Kathryn.stillman_at_dh.gsi.gov.uk