Background General Practices have a duty to serve their local community, and in doing so act as an advocate for further care, and as gatekeepers to the wider NHS. However, as reforms to the NHS erode the geographic basis for care commissioning via SHAs and PCTs, and with GP designed catchment areas largely unrepresentative of the distribution of patients served, particularly in urban areas, there is a need to better understand the characteristics of local enrolment.
Methods A set of “communities” are defined spatially for each of the 47 GP surgeries in the London Borough of Southwark, based upon a complete patient register. Each GP surgery has a set of communities that enclose the smallest geographic area (s) within which a given threshold of the GP surgery’s patients are served. Thus, a 50% threshold will enclose the smallest region (or set of regions) within which half of all that surgery’s patients reside. These, often complex, delineations are based upon the observed spatial distribution of patients, and offer a much finer grain insight into patterns of registration than might otherwise be possible with GP or area level data. These bespoke patient service communities allow for the comparison of a practice population against the resident population, and an analysis of how local communities sort and order themselves by care provider can be made.
Results Evidence from Southwark suggests that patient ethnicity is a major factor in the sorting of population by GP surgeries, with some groups, notably African, Muslim and East Asian patients, being over twice as likely to use particular surgeries than might be expected given their proportion in the normal resident population. As GP service is a constrained system, concentrations in one location can lead to dispersions at others, and a distinct re-mapping of population between residence and service.
Conclusion This research uncovers the spatial dynamics that define patterns of GP registration, demonstrating that the characteristics of patient lists can differ depending on how a community is defined. Insights of this nature are key to a better understanding of how healthcare can be managed, commissioned and improved. They stress the need for robust spatial understandings of “local communities”, and highlight that the patient choice agenda is largely already in effect for dense, diverse urban environments. Improvements in care, particularly by GP-led groups, will come from a better understanding of patient and place.
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