6.1 Introduction

The provision of equitable access to effective health care is one of the founding principles of the NHS. More recently the question of equity has become formally recognised in how the NHS plan services. The Priorities and Planning Framework for the NHS for 2003-2006 stated “that service planning is [to be] informed by an equity audit” (PPF page 20). Encouragement was given that the equity audits should be addressed at the national targets and that they should provide evidence to support commission to close inequality gaps. Many have reported the equity of access in terms of usage rates but few have found ways to report on the equity of access in terms of the physical location of services. This is of particular importance as the location of health services can negatively impact on how frequently patients consult. The further away patients live from their GP, the less frequently they tend to consult (Carr Hill 1997).

This chapter builds on work from previous Key Health Data, on access to food and pharmacies, to identify and describe the populations who live on the edge of what one could call a reasonable distance. The measure of equity is “how long it takes to walk to the closest GP practice, a dentist, a pharmacist or an opticians”. The objective of this work is to provide evidence as to where any new services should be considered and could be built into such tools as the Pharmaceutical Needs Assessments.

The method used here was to take the walking speed of a woman with a pram as a proxy for this less able walker, and to produce iso-chromes (areas of equal time from a location) for each service. The iso-chromes were then matched to 2001 census data at output area level data to provide populations who lived within a 5, 10, 20, 30 or over 30 minute walk from the nearest service.

This chapter is the result of a joint piece of work between the Public Health Information Team for Birmingham, led on this project by South Birmingham PCT and the West Midlands Geographical Information Service.

Figures 6.1- 6.4 show the iso-chromes for the four services and tables 6.1- 6.4 the count and percentage for various measures that characterise the populations who live within the iso-chromes.

6.2 Access to GP Practice

Figure 06.01 Walk times to the nearest GP Practice (Birmingham).

There are 222 GP practices across Birmingham with an average list size of 4,400. There are over 101,000 people (10.3% of the population) who live over 30 minutes walk from their closest GP. In the populations whose needs are likely to be elevated, those with a limiting long-term illness or who are permanently sick, access appears to be slightly better with fewer of those groups living over 30 minutes from a GP. For those with perceivable access issues, lone parents and those without a car, the access again appears better than the general population. For those who live in some of the most deprived areas in the country, access to a GP is far higher than the rest of the population, with over 10% living within 5 minutes walk of a GP.

6.3 Access to Dentists

Figure 06.02 Walk times to the nearest Dentist (Birmingham).

Access to the 175 dental practices across Birmingham is considerably more time consuming than for GP practices. Over 167,000 (17.1%) live over 30 minutes walk from a dental surgery. It is particularly high for pensioners living alone (18.7%).

6.4 Access to Pharmacies

Figure 06.03 Walk times to the nearest Pharmacy (Birmingham).

There are 238 pharmacies across Birmingham, one for every 4100 people. They are the most accessible of all services with only 51,000 people living over a 30 minute walk from their closest. Like GP Practices the most deprived communities have the shortest access times.

6.5 Access to Opticians

Figure 06.04 Walk times to the nearest Optician (Birmingham).

The 195 Opticians across Birmingham are the service from which people live greatest distance away. Over 19% of the population live more than a 30 minute walk from their nearest optician. Accessibility is better for those living in the most deprived areas where over 23% live within 20 minutes of an optician and slightly better for the more elderly who are more likely to live closer to an optician.

References

Carr-Hill R, Place M, Posnett J. Access and utilisation of health care services. In: Sheldon T, Posnett J, eds. Concentration and Choice in Healthcare. London: Financial Times Healthcare, 1997.

Department of Health. Improvement, Expansion And Reform: The Next 3 Years Priorities And Planning Framework 2003 - 2006. London: Department of Health, 2002. http://www.dh.gov.uk/assetRoot/04/07/02/02/04070202.pdf accessed 17 March 2005