Divergence in primary care
What can we learn from Scotland and England?
Contribution to our conference in September 2007
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?
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 Barry US columnist & humorist (1947 - )