Blog entry by Arif Khwaja
In the UK all citizens are entitled to free care at time of need as part of the country's National Health Service (NHS). Introduced in 1945 after the war by a Labour government the NHS ensures that all people receive free healthcare irrespective of their financial status and it has been incredibly popular amongst patients and clinical staff. A cornerstone of the NHS has been the investment in General Practioners (GPs) in primary care. GPs are family doctors responsible for the overall health of their patients and have been in recent years incentivised to take on management of non-communicable chronic diseases such as CKD, Diabetes and hypertension.
Last week I came across an interesting, if somewhat depressing analysis of healthcare resources in my own city of Sheffield from Dr Parvez Hossain and colleagues. Whilst the number of GPs per head of the population was the same across the city when social deprivation was factored in there were some startling differences - those with non-communicable diseases from socially deprived areas had far fewer GPs. Or to put it another way the number of GPs per head of the population was the same for the most affluent and the most deprived -BUT the poorer you were the more likely you were to have an NCD and so you effectively had access to less healthcare. Reading the paper reminded me of the graph I saw at medical school on the impact of vaccination and antibiotics on the decline of infectious diseases such as TB, cholera and typhoid - the effect of all these interventions was minimal when set against improvements in housing and sanitation. Similarly the battle against NCDs such as diabetes and CKD will require societal and governmental action to have the biggest impact.
The paper highlights what has long been recognised as the inverse care law of healthcare - ie those that that need healthcare the most often have the least access to it - even in systems such as the UK which have a relatively sophisticated and equitable form of healthcare. As individual clinicians we need this kind of data to understand the population we work in so we can try to impact on healthcare at a societal level.