GPs should be barred from taking up new jobs in wealthy areas and directed to work in deprived regions in order to “level up” health inequalities, a think-tank says today.
The Social Market Foundation has published plans for family doctors to face new restrictions on where they can practice, to address severe shortages of GPs in the poorest parts of England.
The proposal is made in a paper by John Gooderham, a former senior official at the Department of Health.
England as a whole is short of GPs, but shortages are much more severe in deprived areas. Gooderham’s calculates that doctors in the poorest parts of the country can be responsible for twice as many patients as GPs in more affluent areas nearby.
The shortage of GPs in deprived areas contributes to major differences in health and life expectancy across England, with people in poor places dying as much as ten years earlier than those in wealthier locations.
Gooderham says that the answer to these imbalances is to create a new government body with the legal power to decide whether a GP could go to practice in a particular area. Places with relatively high numbers of doctors would be deemed “closed” to new GPs, who would have to go to less well-served locations to work.
The new body would be called the Office for Equitable Distribution of GPs in England (OFEDGE) and be modelled on body that was in place until 2001, but was then abolished under pressure from the British Medical Association, the doctors’ trade union.
Under the proposed system, any Primary Care Network – a local group of GP practices – that wanted to create new GP jobs and hire additional doctors would have to apply to OFEDGE for approval.
Where the new body judged that the area had enough doctors relative to other areas, it could veto new appointments. The result would be that the only places where GPs seeking new posts could find work would be those that OFEDGE found to be in greatest need of more doctors.
A better system of distributing GPs around the country is needed because of the stark disparities in medical cover between wealthy and deprived places.
Gooderham’s analysis of NHS data finds major differences between poor and rich areas –
- At the level of Clinical Commissioning Groups – which typically cover counties – there are often fewer than 2,000 patients per full-time equivalent GP: Oxfordshire with 1,688; Wirral with 1,720; West Suffolk with 1,731; and East Staffordshire with 1,745 patients per FTE GP.
- By contrast, poorer places can have almost 3,000 patients per doctor: Fylde and Wyre with an average list of 2,833 patients per FTE GP; Hull with 2,761; Calderdale with 2,606; Thurrock with 2,592; and Portsmouth with 2,559.
Gooderham also analysis numbers per Primary Care Network, and finds much greater disparities, sometimes within cities. More affluent suburbs have many more doctors than poorer city centre areas:
- Blackpool North’s GPs each cover 4,480 patients. In Blackpool South the figure is 1,900
- In Reading Central the average is 5,111, while in Reading West it is 2,987.
John Gooderham, former senior official at the Department of Health, said:
“Deprived areas are being worst affected by shortages of GPs. That trend is increasing, and is widening health inequalities. Where GPs work should no longer be left entirely to market forces, as has happened for the past 20 years.
“Creating a new Office for Equitable Distribution of GPs in England would be a simple and effective way to help address that trend, and could be done soon by amending the Heath and Care Bill now going through Parliament.”
James Kirkup, Director of the Social Market Foundation, said:
“If levelling up is to mean anything, it must include addressing health inequalities. People in deprived areas have worse health and die earlier than people in wealthier places, yet there are fewer doctors in those deprived areas.
“It’s understandable that GPs might choose to work in wealthier places where they have to treat fewer patients, but those choices mean the people in greatest need of better healthcare don’t get it. Anyone who wants to level up the country should address this by getting more doctors to work where they’re most needed.”
Gooderham’s paper is published today by the Social Market Foundation as part of a collection of essays about general practice and its future. All the essays can be found at: https://www.smf.co.uk/publications/future-of-general-practice/
- Gooderham proposes that the new OFFEDGE could be created by a simple amendment to the Health and Care Bill, which will shortly be debated in the House of Lords.
- OFFEDGE would be modelled on the Medical Practices Committee for England and Wales (MPC), which was created in the NHS Act of 1946 and abolished in 2001 as part of a new contract of employment for GPs.
- Gooderham Secretary of the MPC from April 1981 to December 1983, and from May 1995 to October 1999.
James Kirkup on firstname.lastname@example.org and 07815 706 601