Flashcards in Geographies of care Deck (23):
What are the levels of healthcare?
- the majority of healthcare is done by yourself- for a cold or tummy ache
- primary healthcare- GP, dentist
- secondary healthcare- hospital care
- tertiary care- specialised care (might not be local)
What's healthcare in the UK like?
- NHS is a collectivist system
- Free at the point of delivery- some charges but with exceptions
- In theory access to care in the UK is universal and equitable as it is not based on the ability to pay
How is GP care organised?
- Organised into Clinical Commissioning groups (CCGs) which commission health services for patients
- Used to be Primary Care Trusts
Why might it not be fair that over 60s get free prescriptions?
- Many pensioners are very wealthy
- Makes access to healthcare less equal
How does number of GP per population vary geographically?
- Very wildly
- Over 76 per 100,000 people in Cumbria, Cornwall, Devon and Camden
- Fewer than 57 per 100,000 in Nottinghamshire, Ribble Valley and Greenwich
How has the size of GP practices changed?
Single handed GP practice- 32% in 1991, 11% in 2012
Six or more GPs- 9% in 1991, 44% in 2012
- Single handed practices in urban areas, particularly inner London and Birmingham
Why is there a crisis in GP recruitment?
- GPs are retiring early
- Medical students don't particularly want to be GPs- only 1 in 10 and the govs aim is 1 in 2
What type of social determinant of health is access to healthcare services?
- A living and working conditions social determinant of health
- Can mitigate the effects of poor health by reducing and delaying the severity of conditions
Will healthcare reduce health inequalities?
depends on the extent to which it is delivered in proportion to need across the socioeconomic spectrum
What is the inverse care law?
(Tudor Hart, 1971)
- The inverse care law states that the availability of good medical care varies inversely in proportion to those who need it most.
- Argues that health workers need to understand the anatomy of society as well as the anatomy of the human body (Societal view of health)
Data to back up the inverse care law?
(Shaw and Dorling, 2004)
- Used census data and the GP register
- Found an inverse relationship between population with healthcare and number of qualified medical practitioners
Evidence for the positive care law (GPs and Pharmacies)?
(Todd et al, 2005)
- Proportion of the population without access to a GP within 20 minutes walk falls as population gets more deprived
- It's the middle class who are furthest from GPs
- Used walking because it's the most accessible for everyone
- Inverse care law is simplistic
Evidence for the positive care law (informal care)?
(Shaw and Dorling, 2004)
- Almost perfect corrolation
- As proportion of population with health needs increases so does the proportion of the population providing 50 hours or more per week of free care
What is wrong with the arguments for the positive care law?
- It only measures the availability of provision
- What about quality?
- We tend to find is that those living in poverty are sicker, have more multi-morbidity, but this means they may take up more time than others, leading to pressure on the service (and GP ‘burnout’).
- So while there might be more GP in more deprived areas it doesn't mean needs are necessarily met
What is the issue with getting GP appointments?
- Since 2011-12 there been a year on year increase in difficulty getting through to practices, longer wait for appointments and dissatisfaction with opening hours (Nuffield Trust)
- People struggling to see the same GP
- Appointments are really short (aim for 10 minutes)
- patients feel like they're just a number
- Patients want hollistic MPs who understand life
- Same issues with the dentist
What issues are the GP issues causing for GPs?
- Almost 6 million people turn to A&E every year because they cannot get help from their GP
-use of this as an alternative to primary care simply overloads that service.
- NHS111 is useless
How does access to dentist appointments vary across England?
- In Devon, Cornwall and the Isles of Scilly only 5 of 18 dental practices accepting new NHS patients offered researchers an appointment
- All of the 16 surgeries in Kent and Medway gave appointments
- better availability in London than across the rest of the country
What's the relationship between deprivation and dental disease?
- As income support increases the mean number of decayed, missing or filled teeth increases
- Areas in London with the under 5s with the most dmf teeth are Tower Hamlets and Newham
What are the sugestions to reduce pressure on GPs?
- 70% GP patients don't need to attend a surgery
- Consult a pharmacy instead
- Some GPs are providing virtual consultations privately- e.g. Dr Morons
Is technology a good answer to accessing healthcare?
- video consultations, increased appointments and varied times and increased access to those unable to leave the house
- but what's it like for the patient
- Feels less thorough
Is centralisation of services a good thing?
- Provides NHS economices of scale
- But means patients have to travel further
-distance decay- the closer you are to a service the more likely you are to use it
- better health outcomes for those who live closer to healthcare facilities
Where does the inverse care law operate most completely?
- Where medical care exposed to market functions- privatised