Areas of England where the largest proportion of ethnic minorities live have the poorest access to GPs, with experts putting this disparity down to an outdated model used to determine funding.
According to a Guardian analysis of NHS Digital and census data, in October 2023 there were 34 fully qualified full-time GPs per 100,000 patients in the areas with the highest proportion of people from ethnic minorities.
This is 29% lower than the 48 GPs per 100,000 residents serving areas with the highest percentage of white British.
Although ethnic minorities are generally younger than the white British population, ethnic minority areas still have the lowest number of GPs per person, even when factors such as age, gender and health needs are taken into account.
After adjusting for these factors, high ethnic minority areas had 37 GPs per 100,000 patients, 15% fewer than the 44 GPs per 100,000 in the lowest ethnic minority places in England.
Professor Miqdad Asaria from the health department at the London School of Economics said it was “deeply concerning” that ethnic minorities “have systematically poorer access to primary care, which is likely to be a major driver of current and future health inequalities”.
“Primary care plays a crucial role in preventing disease, diagnosing and treating disease, and facilitating access to specialist or hospital treatment for people who need it,” he added.
Deprivation and population density play a role in this inequality. People from most ethnic minority groups are more likely to do this live in deprived areas and more densely populated places than the white British population, with socio-economic poverty being a key factor affecting health.
The analysis also shows that, after adjusting for factors such as gender, age and health needs, the number of GPs per patient in the most deprived parts of England is 13% lower than in the most affluent areas. It is also 16% lower in the most densely populated areas of the country than in the least densely populated areas.
Experts have said that the large difference between the number of GPs in different local authorities is due to the fact that the Carr-Hill formula, which is used to determine how much money is allocated per patient to each GP practice, does not sufficiently take into account with how factors such as deprivation and ethnicity can influence an area’s health outcomes.
Jake Beech, a policy fellow at the Health Foundation, said the formula “did not appropriately compensate practices for the additional healthcare needs associated with poverty, shifting funding to more affluent areas.
“People living in (deprived) areas often have higher health needs, and our research shows that, after taking these higher needs into account, GP practices in more deprived areas are undertreated and underfunded compared to more affluent areas,” said Beech.
“The main driver of this is the formula used to allocate funding to GP practices. The formula has been around for over 20 years and despite numerous promises to change it, this has still not happened. Policymakers must distribute funding and staffing in general practice more equitably, so that resources better match needs.”
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Beccy Baird, a senior fellow in health policy at the King’s Fund, said it is “widely recognized” that the Carr-Hill formula “does not adequately capture the additional costs associated with deprivation”.
She added: “It is also harder for GP practices in deprived areas to meet the quality targets they need to meet to receive additional funding (known as QOF), such as how well patients control their diabetes, because their patients may need more money. support than those in wealthier areas. This means practices in underserved areas may not be able to afford as many staff as they need to meet the needs of their patients.”
The analysis also shows that inequality in London is at its highest level. The number of GPs per patient is a quarter lower in areas of the capital with the highest proportion of ethnic minorities compared to those with the lowest proportion of people from an ethnic minority background.
A spokesperson for the Department of Health and Social Care said: “We are committed to eliminating health inequalities across the country so that everyone can live longer, healthier lives, and we have always prioritized the NHS by supporting it with the funding it needs.
“We are committed to improving access to GPs, and we now provide 50 million more GP appointments per year compared to 2019.
“The latest data shows that GP funding has increased by 19% in real terms between 2017-2018 and 2021-2022, and our primary care recovery plan is investing up to £645 million to expand pharmaceutical services and reduce pressure in general practice.”