THE EFFECT OF DEPRIVATION ON VARIATIONS IN GENERAL-PRACTITIONERS REFERRAL RATES - A CROSS-SECTIONAL STUDY OF COMPUTERIZED DATA ON NEW MEDICAL AND SURGICAL OUTPATIENT REFERRALS IN NOTTINGHAMSHIRE

Objective: To determine the effect of deprivation on variations in gen eral practitioners' referral rates using the Jarman underprivileged ar ea (UPA(8)) score as a proxy measure. Design: Cross sectional survey o f new medical and surgical referrals from general practices to hospita ls (determined from hospital activity data). Setting: All of the 183 g eneral practices in Nottinghamshire and all of the 19 hospitals in Tre nt region. Main outcome measures: The relation between the referral ra tes per 1000 registered patients and the practice populations's UPA(8) score (calculated on the basis of the electoral ward), with adjustmen t for the number of partners, percentage of patients aged over 65 year s, and fundholding status of each practice.Results: There was a signif icant independent association between deprivation, as measured by the UPA(8) score, and high total referral rates and high medical referral rates (P < 0.0001). The UPA(8) score along explained 23% of the total variation in total referral rates and 32% of the variation in medical referral rates. On multivariate analysis, where partnership size, fund holding status, and percentage of men and women aged over 65 years wer e included, the UPA(8) score explained 29% and 35% of the variation in total and medical referral rates respectively. Conclusion: Of the var iables studied, the UPA(8) score was the strongest predictor of variat ions in referral rates. This association is most likely to be through a link with morbidity, although it could reflect differences in patien ts' perceptions, doctors' behaviour, or the use and provision of servi ces.