Deprivation and general practitioner workload.

OBJECTIVES--To examine general practitioner consultations by demographic and socioeconomic variables and to derive a method of measuring the impact of relative deprivation on general practitioner workload. DESIGN--The study was based on general practitioner consultations reported in the general household surveys of 1983-7, covering a sample of 129,987 individuals in Great Britain. Odds ratios for general practitioner consultations were obtained for selected variables among children (0-15 years), men (16-64), women (16-64), and elderly people (greater than or equal to 65). These were then used to derive deprivation indices specific to electoral wards for use in general practice. SETTING--Great Britain, with particular findings illustrated by English electoral wards and the conurbations of London, Manchester, Merseyside, and the West Midlands. RESULTS--Council tenure increased the likelihood of consultation significantly in all four groups. Odds ratios were raised in children, men, and women with no access to a car. Birth in the New Commonwealth or Pakistan yielded high odds ratios in men, women, and elderly people but not in children. Marginally increased consultation rates were evident in the manual socioeconomic groups in women, elderly people, and children with a single parent mother. The deprivation indices for general practice derived using these odds ratios varied substantially among English electoral wards with, for example, anticipated general practitioner consultations in the electoral ward of Hulme, Manchester, being 24% higher than the average ward in England as a result of local attributes, and consultations in the Cheam South ward of Sutton, London, 11% lower than average. CONCLUSION--This deprivation index for general practice overcomes several shortcomings expressed about the underprivileged area score, which has been adopted in the 1990 contract as a basis for allocating deprivation supplements to general practitioners. The proposed index can be applied nationwide.     

Do general practitioner deliveries constitute a perinatal mortality risk?

In recent years local perinatal mortality experience has been on the agenda of most health district management teams. Nationally available data have been criticised for failing to take into account determinants beyond the influence of existing health services such as lethal congenital malformations. In response to local concern about perinatal mortality rate in Oxfordshire AHA(T) the crude data were refined by using simple epidemiological techniques. This failed to show that a high proportion of general practitioner deliveries constituted a major perinatal risk.     

The general practitioner as sports physician.

General practitioners must become more knowledgeable about sports medicine in order both to treat the injured athlete and to provide better rehabilitative treatment and advice on fitness and exercise to other patients. Close involvement with young amateur athletes also helps to keep the older physician "in tune" with the younger generation. Finances remain a major problem for amateur sporting events and sports medicine groups, as well as for the individual physician volunteering his time.     

Ethnic differences in general practitioner consultations.

OBJECTIVE--To examine the levels of general practitioner consultations among the different ethnic groups resident in Britain. DESIGN--The study was based on the British general household surveys of 1983-5 and included 63,966 people aged 0-64. Odds ratios were derived for consultation by ethnic group by using logistic regression analysis adjusting for age and socioeconomic group. SETTING--The results relate to people living in private households in England, Scotland, and Wales. RESULTS--After adjustment for age and socioeconomic class, consultation among adults aged 16-64 was highest among people of Pakistani origin with odds ratios of 2.82 (95% confidence interval 1.86 to 4.28) for men and 1.85 (1.22 to 2.81) for women. Significantly higher consultations were also seen for men of West Indian and Indian origin (odds ratios 1.65 and 1.53 respectively). Ethnic differences were greatest at ages 45-64, when consultation rates in people of Pakistani, Indian, and West Indian origin were much higher in both sexes compared with white people. CONCLUSIONS--The ethnic composition of inner cities is likely to influence the workload and case mix of general practitioners working in these areas.