CHANGE IN GENERAL-PRACTICE AND ITS EFFECTS ON SERVICE PROVISION IN AREAS WITH DIFFERENT SOCIOECONOMIC CHARACTERISTICS

Objective-To investigate the changes in the structure and service prov ision of general practice in areas with different socioeconomic charac teristics. Design-Interview survey; postal questionnaire. Setting-260 group and 80 singlehanded general practices in six family health servi ces authorities in England. Main outcome measures-Changes in computeri sation, premises, staffing, incomes, and service provision since the i ntroduction of the 1990 contract, including comparison with data from a study in 1987. Results-In 1993, 94% (245) of group practices were co mputerised compared with 38% in 1987, and 35% (90) of practices had us ed the cost rent scheme since 1987. Practice managers were employed in 88% (228) of group practices, and practice nurses in 96% (249) (61% a nd 60% respectively in 1987). Diabetes and asthma programmes were gene rally more common in the more affluent areas than elsewhere. A minorit y of practices (27% (9/33)) in the London inner city area achieved the higher target level for cervical smear testing, compared with 88% (23 0) overall. A similar trend was apparent for childhood immunisation. P erceived workload increased sharply between 1987 and 1993. Differences in the mean net incomes of general practitioners between areas were m uch lower than in 1987. Singlehanded practices generally had more prob lems than group practices in improving service provision. Conclusions- Practices in all areas have shown a strong response to the new incenti ves. The evidence suggests, however, that generally the urban and inne r city practices still lag behind practices in rural and suburban area s in terms of practice structure and service provision.