Re: Multimorbidity and the inverse care law in primary care
7 August 2012
Mercer et al describe the important influence of deprivation on medical workload explaining that multi-morbity occurs 10 to 15 years earlier in deprived populations.They use this to develop the argument that practitioners in deprived areas are relatively short of time,exacerbating further the effects of undersupply of GPs.
Tudor Hart's inverse care law has inspired me since I became a GP but in this case the argument made is partially flawed.
It is the number of individuals in an area who have multi-morbidity which determines workload, in this context, not the age at which they develop it.
In our locality area our population structure is similar to that which we expect to see across the country in 20 years time: 5.1% of people are over 85 years old and another 4.9% over 80.
Our area is relatively affluent yet in the year to february 2011 this group used 57% of all hospital bed days and represented 36% of all emergency admissions to hospital. It is inconceivable that secondary care and primary care workloads are not linked.
Primary care workload statistics are more difficult to collect but the rise in my practice is such that whilst in 1990 one column per Gp in a standard practice message daybook was mostly sufficient,we have now reached 5 columns on some days.
It is inexcusable that the NHS does not attempt to match GP distribution to the clinical need of populations served but "too little consultation time" is a shared problem and at present in East Devon it does not feel as though the effects of old age are over-resourced.
Competing interests: Co chair of Wakley Locality Commissioning Group
Axminster Medical Practice, Church St, Axminster EX13 5AG
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