Trends in geographical inequalities in provision of general practitioners in England and Wales

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The figure plots the trend in the inequality index based on both actual and need-adjusted populations. There was a decline in inequality from 1974 to mid 1980s but inequality then stopped falling and may even have increased. In 1995, 2·9% of GPs would have had to move to achieve an equal provision per head of population. Equal provision per head of need-adjusted population would have required the movement of 5·2%. This would have implied substantial changes in GP/need-adjusted population ratios for some areas: the maximum increase required was 36·7% and the maximum decrease was 26·8%. The finding that there is still substantial inequity is supported by other studies. The distribution of GPs is regulated by the Medical Practices Committee (MPC) which defines two types of under-doctored areas: designated (less than 4 GPs per 10 000 population) or open (between 4 and 4·8 GPs per 10 000). The numbers living in open or designated areas fell from 30·4 million in 1974 to 3·4 million in 1994. The MPC argues that it has been successful in reducing inequality. The MPC uses an absolute inequality concept: provision is compared to some absolute standard. The Robin Hood index reflects relative inequality: provision is compared between areas. A 10% increase in the number of GPs in all areas would reduce absolute inequality but would have no effect on the Robin Hood index. Our finding that there has been no recent reduction in relative inequality suggests that new methods for influencing the location of GPs should be considered.