Socialist Health Association Promoting Health through Socialism

Divergence in primary care

What can we learn from Scotland and England?

Kate O’Donnell
General Practice & Primary Care, University of Glasgow.

Population size of health regions in the UK

London	7.43 million
North West	6.83 million
East of England	5.49 million
West Midlands	5.33 million
Scotland	5.12 million
Yorkshire & The Humber	5.04 million
South West	5.04 million
East Midlands	4.28 million
South East Coast	4.19 million
South Central	3.92 million
Wales	2.97 million
North East	2.55 million
Northern Ireland	1.74 million

Rurality

Number of people per hectare by Council area (2001 Census).

Scotland and deprivation

Directly standardised mortality rates per 1,000 population, 1990/92, by country and deprivation quintile

Source: PHIS Chasing the Scottish Effect 2001, Glasgow Centre for Population Health

Long-term unemployment (% of unemployed aged 16-74).

Long term limiting illness across the UK

London	15.1
North West	17.8
East of England	15.4
West Midlands	16.0
Scotland	17.3
Yorkshire & The Humber	16.6
South West	14.0
East Midlands	13.3
South East	12.6
Wales	19.4
North East	19.4
Northern Ireland	19.5
England	15.2
UK	15.7

Keep Well

Targeting hard-to-reach populations:
- 45 – 64 year olds in most deprived communities.
Improve reach and engagement.
- Once engaged – improved primary prevention.
improved secondary prevention.
- Piloted in 5 CHPs; 7 more later this year.
- Over 90 practices involved.
What will be the outcome for patients; for practices; for the wider NHS?

Where do we go from here?

see Better Health Better Care

Conclusions

Scotland continues to reject a marketised approach to health care.
Greater move towards health and social care integration.
Anticipatory care high on agenda.
Governance and monitoring low-key, but may not remain like that.
Need to address twin issues of inequality and deprivation continues to influence Scottish health policy.

"We Americans live in a nation where the medical-care system is second to none in the world, unless you count maybe 25 or 30 little scuzzball countries like Scotland that we could vaporize in seconds if we felt like it."

Dave BarryUS columnist & humorist (1947 - )

last updated 3/10/07