The Times report that GPs are to be barred from taking posts in affluent areas to force them to work in deprived towns under plans being considered by the government.
Poor areas can have almost half the number of doctors per head as richer places and closing the gap is essential to Boris Johnson’s levelling-up goals, the Social Market Foundation think tank says in a report today.
They go on:
Nationally there is one full-time GP for every 2,289 patients, a ratio that has been worsening. But this falls to one GP per 1,688 in Oxfordshire and 1,731 in West Suffolk. Yet in Fylde and Wyre in Lancashire there are 2,833 patients for each GP, 2,761 in Hull and 2,559 in Portsmouth. The gap can be bigger within towns, with Blackpool North having 4,480 patients for each full-time GP, but only 1,900 in Blackpool South.
A body called the Medical Practices Committee had the power, until its abolition under Tony Blair’s health reforms 20 years ago, to deal with these discrepancies by refusing applications for GPs to work in areas that were “adequately doctored”.
In an essay for the Social Market Foundation, John Gooderham, a former secretary to the committee, argues that it worked in ensuring that very few areas were “under-doctored” by the late 1990s. He has called for a return to a similar system as part of a health bill going through parliament.
“Deprived areas are being worst affected by shortages of GPs. That trend is increasing, and is widening health inequalities,” Gooderham said. “Where GPs work should no longer be left entirely to market forces, as has happened for the past 20 years.”
In another article written some time ago now, James Kirkup noted:
The places where those doctors are most needed are the areas where patients have the least money. This is not new. In 1971, Julian Tudor Hart, a GP and researcher, described the “inverse care law” of general practice: poorer local populations have greater health problems and need more care but actually get less of it. Today, GP practices in the most deprived areas have larger lists, get lower quality ratings from regulators and offer shorter consultations than those in more affluent places. Once again, money is the problem.
Worse healthcare contributes to worse health and shorter lives. Men in the poorest areas die a decade earlier than those in the richest postcodes; for women, the gap is eight years. Fixing this will take decades of effort on many fronts. That effort could start with getting more GPs to poorer places, using money to drive them there.
I commented on that story this way at the time:
Interestingly, just as the inverse care law of general practice mirrors exactly what might be called the inverse gospel law of church: the poorer the area, the greater the needs yet the less likely you are to find a gospel preaching church in their midst. What churches do exist in those places are more likely to have deeper need of resources within their congregations and yet are far less likely to have them.
But just as the inverse care law mirrors the inverse gospel law, I think the solution being mooted by the Social Market Foundation for GPs might well work for the church. We need to encourage the movement of people and resources to the place that most need them. In my view, this requires a radical shift in how we help this.
One radical suggestion, put by Steve Bell on this blog, is to refuse to fund new church plants and revitalisations in middle class and affluent areas for around 10 years. He states:
As far as I can tell, most evangelical church planting in the UK is at least partially funded by a fairly small number of either national or regional church networks, some wealthier churches and the associated funds/trusts that they can access. I reckon that there are sufficiently few of these organisations that (post COVID!) you could get senior representatives from all of them together in one room. My suggestion is that this is done and that they agree together that for the next ten years all the new church plants that they help to finance in the UK will be in the more deprived communities (either urban or rural) that we have previously neglected, and that they will no longer help fund further new church plants in predominately middle class or newly gentrified areas.
Likewise, I think we should seriously consider doing something similar with funding. For the next 10 years, resources for churches in deprived places should be prioritised over any applications for those from more affluent or gentrified areas. This is not to stop churches outside of these communities from receiving any support, but to redress the fact that in-house they are likely to have more resources and the fact that both the needs, and the dearth of churches altogether, in deprived communities needs to be addressed.
Just as the way to get GPs to move to where they are most needed is to, essentially, bar them from practising in affluent communities, so the way we are going to see the balance of churches across our nation adequately addressed is to essentially stop the funding of those plants and revitalisations in the areas that are already well churched. I am not saying that we shouldn’t have churches and revitalisations in affluent or gentrified areas, I am simply arguing that the gospel deficit in our country – that affects the poorest and most deprived hardest – is best addressed by funnelling the resources we have to them. It seems to me that an effective bar on funding and resourcing churches in affluent communities for 10 years would go some way to helping address the problem.
If it can work for getting GPs where we most need them, there is every reason to believe that it can work for getting churches and gospel workers where we most need them too.