Counting the cost of social disadvantage in primary care: retrospective analysis of patient data

Abstract Objective: To cost the relation between socioeconomic status and various measures of primary care workload and assess the adequacy of current “deprivation” payments in relation to actual costings for patients living in qualifying areas. Design: Retrospective data on primary care were collected over a 4.5 year period from both computerised and manually filed records. Standardised data on socioeconomic status were obtained by postal questionnaire. Setting: Inner city group practice with a socioeconomically diverse population. Subjects: 382 male and female subjects of all ages, with a total of 1296 person years of observation. Main outcome measures: Primary care costs resulting from consultations with a general practitioner or a practice nurse and both new and repeat prescriptions. Results: Morbidity, workload, and costs of drug treatment increased with decreasing socioeconomic status. The difference in cost for patients in social classes IV and V combined compared with those in I and II combined was about £150 per person year at risk (£47 for workload and £103 for drugs). Deprivation payments met only half the extra workload cost for patients from qualifying wards. Conclusions: The greater workload caused by social disadvantage has been previously underestimated by simple consultation rates. The absolute difference in costs for socially disadvantaged patients increases as more detailed measures of workload and drug treatment are included. Current deprivation payments only partially offset the increased expenditure on workload. This shortfall will have to be addressed to attract general practitioners to, or retain them in, deprived areas. Key messages The costs of providing primary health care including drug treatment increased with decreasing socioeconomic status from £107 in social classes I and II to £256 in IV and V per person year at risk Previous studies that used simply consultation rates have underestimated the differences by socioeconomic status compared with the use of more detailed measures of cost Repeated drug treatment, indicating chronic illness, was the largest component of the total drug and labour cost The additional workload costs for patients from qualifying electoral wards were only partially offset by deprivation payments Additional deprivation payments could be used to expand the work of practice nurses, although this needs further evaluation