Although need is often assumed to be the most important factor in determining the use of health services, there are many inequities in the provision and use of NHS services in both primary and secondary care. For example, existing data from district child health information services have been combined with census data for small areas to show wide variations in immunisation rates between affluent and deprived areas. Purchasers of health care are already responsible for assessing health needs and evaluating services, and the process of monitoring equity is a logical extension of these activities. Routine data sources used to collect activity data in both primary and secondary care can be used to assess needs for care and monitor how well these needs are met. Purchasers and providers should collaborate to improve the usefulness of these routine data and to develop a framework for monitoring and promoting equity more systematically.

Despite access to health care on the basis of clinical need always having been a central tenet of the NHS,1 there are still many inequities in the provision and use of health services in Britain. These inequities are partly a result of the variable provision of services inherited by the NHS at its inception in 1948. As the first two papers in this series have shown,^2,3 the NHS has made considerable progress in reducing these inequities. Nevertheless, policies aimed at redistributing services more fairly have often not considered how this can be achieved in practice, and inequities still persist in both primary and secondary care.

In primary care there are large variations in the use of general practitioner services. Young children, elderly people, residents of socially deprived areas, and members of ethnic minorities have a greater need for care and have higher than average consultation rates.*RF 4-6* However, deprived …