Quantifying unmet need in General Practice: a retrospective cohort study of administrative data

OBJECTIVES: To assess whether patients attending general practices (GPs) in socioeconomically (SE) deprived areas receive the same amount of care, compared with similar patients (based on age, sex and level of morbidity) attending GPs in less deprived areas. If not, to quantify the additional resource that would be required by GPs in deprived areas to achieve parity. DESIGN: Retrospective cohort study. SETTING: 150 GPs in Scotland, UK, divided into two groups: 80 practices in Scottish Index of Multiple Deprivation (SIMD) deciles 1-5 (more SE deprived); 70 practices in SIMD deciles 6-10 (less SE deprived). PATIENTS: 437 590 patients registered with a more SE deprived GP, and 333 994 patients registered with a less SE deprived GP, for the whole study period (2013-2016), who made at least one appointment. OUTCOMES: The number of contacts and total contact time between patients and clinical staff. RESULTS: Patients in more SE deprived areas had slightly more discrete contacts over 3 years (11.8 vs 11.4), but each patient had marginally less contact time (146.1 vs 149.5 min). Stratified by sex and age, differences were also small. Stratified by the number of long-term conditions (LTCs), practices in more SE deprived areas delivered significantly less contact time than practices in less SE deprived areas. Over 3 years, 8 fewer minutes for patients with no LTCs, and 24, 27, 38 and 28 fewer minutes for patients with 1, 2, 3-4 or 5+LTCs, respectively. CONCLUSION: If GPs in more SE deprived areas were to give an equal amount of direct contact time to patients with the same level of need served by GPs in less SE deprived areas, this would require a 14% increase in patient contact time. This represents a significant unmet need, supporting the case for redistribution of resources to tackle the inverse care law.