A team of experts from the University of Glasgow studied data collected from 793 general practices across Scotland, 83 per cent of the total, serving 4.4 million patients over a three year period from 2010 to 2013. They found that patients from socially deprived areas were more likely to be excluded from attending chronic disease management (CDM) reviews on a “three-and-your-out” basis, meaning anyone missing three invited reviews in a 12-month period was no longer asked to attend a GP appointment.
A chronic disease is defined as something long-standing, over three to six months which cannot be “cured” by medication but is managed. This covers illnesses like strokes, diabetes and heart disease. The authors’ recommendations include further commitment to engage with “hard to reach” people in disadvantaged areas who have a greater burden of multiple chronic conditions and may be more likely to miss appointments at their GP, despite increased need.
Reasons for this include difficulties securing time off unstable work, caring for young children, not understanding the need to attend, not receiving the invitation or being unable to afford transport costs.
Professor Frances Mair, one of the report’s authors, from the University of Glasgow, said the exclusion didn’t mean you were kicked-out of your local surgery but would not be asked to attend any further reviews specifically related to a particular chronic illness. A patient was given a separate review for each chronic disease they have.
She said: “One of the things we found was that people from deprived areas are likely to have more multi-morbidity, so they’re likely to have two or more chronic conditions. That’s one example of a reason why people may not come for all of their reviews – if you’ve got a whole lot of reviews to attend it’s more work for you.”
The study looked at the Quality and Outcomes Framework (QOF) which was scrapped by the Scottish Government last year.
Health secretary Shona Robison said: “Tackling inequalities is a key outcome of our primary care strategy reflected in our joint memorandum with the BMA. Through the recruitment and retention fund we are supporting the deep end pioneer scheme which is doing valuable work to bring new GPs into practices in deprived areas.”