Policy briefing: General Practice in socio-economically deprived areas

Urgent investment and specific policy responses are needed to support a sector that is vital to tackling inequalities between people, places and regions
General Practice in the areas of high socio-economic deprivation faces a set of challenges common to general practice as a whole, but with a different level of intensity and a set of specific issues. Investing in primary healthcare for the poorest communities should be an essential part of the “levelling up” agenda or efforts to “smash the class ceiling”.


  • Fully qualified GP numbers are in decline, with the average GP now looking after twice as many patients as is recommended for optimal primary care – addressing this is essential *
  • The inverse care law applies to the distribution of primary care staff, with fewer GPs per 1000 patients in the most deprived commissioning group areas and a faster rate of decline
  • Primary care teams in the most deprived areas have diversified more quickly as a result of inequitable supply of GPs (i.e. via additional roles being employed – advanced clinical practitioners, paramedics, physiotherapists etc), which is welcome but has placed a significant training and supervision burden on GPs 
  • There are higher levels of burnout and stress among GPs working in the most deprived areas
  • GP training tends to be concentrated away from inner city areas and areas of high deprivation

Access, continuity and funding
  • The demand for GP appointments in poorest neighbourhoods is 15-30% higher than in the most affluent areas . Funding formulae for core primary care do not reflect this .
  • High list turnover as a result of more itinerant populations plus fewer GPs, high demand and a more diverse workforce, means that continuity is reduced
  • There is lower satisfaction with primary care access in the most deprived neighbourhoods, perhaps reflected in higher unscheduled care attendances in these populations, especially use of Emergency Departments

System failures

  • Falling life expectancy is mirrored by falling disease-free life expectancy, meaning that patients in poorer areas spend more of their lives in poor health and need more help from primary and secondary care
  • Reductions in the public health grant and local authority funding means cuts to healthcare services that are disproportionately in higher demand in poorer areas: health visiting, school nursing, contraception and sexual health, drug and alcohol services, smoking cessation and some mental health services.

Capital investment

Policy responses

  • Investment in primary care workforce and capital that reflects population need
  • Return levels of funding to other community services to 2010 levels in order to support primary care and the NHS as a whole, alongside an renewed offer that is equitable and reflects need
  • A significant expansion of the primary care workforce with a specific focus on the training needs of clinicians who will serve socioeconomically deprived communities
  • A Government wide focus on addressing health inequalities and social determinants of health, prioritising the health and wellbeing of children living in the poorest neighbourhoods

* note of FTE GP numbers: statistics that show an increase in the number of full time equivalent GPs include GP trainees, who make a valuable contribution, but are not independent practitioners and who require intensive supervision from other members of the team as part of the their training.