Levelling up or left behind? are GP training opportunities in northern Ireland widening or closing the gap on health inequalities?

Abstract

Increasing the GP workforce will not necessarily level up healthcare provision: instead increasing GP training numbers could worsen health inequity and inequalities. This is especially true if there are fewer opportunities to learn, train and build confidence in under-served, socioeconomically deprived areas. To investigate the representation of socioeconomic deprivation in postgraduate GP training practices in Northern Ireland (NI). Socioeconomic deprivation indices and scores of GP practices in Northern Ireland were calculated. We compared the socioeconomic deprivation indices and scores of GP postgraduate training practices against general practice in NI by examining the representation of practices whose patients live in areas of blanket deprivation, higher deprivation and higher affluence. Of 319 practices in NI, 171 (54%) were registered as postgraduate training practices with a mean deprivation score of 3.02 (95% CI 2.91-3.12) compared with non-training practices' higher mean deprivation score of 3.2 (95% CI 3.01-3.33), P-value <0.05. The proportion of training practices with blanket deprivation and higher levels of deprivation was underrepresented, with the current postgraduate GP training practices having more affluent populations. Postgraduate training practices had a statistically significant lower deprivation score and did not fully reflect the socioeconomic make-up of wider NI general practice. The results, however, are more favourable than in other areas of the UK and better than undergraduate teaching opportunities in general practice. Health inequalities will worsen if the representation of general practice training in areas of greater social economic deprivation is not increased.