Are general practitioners in inner Manchester worse off than those in adjacent areas?

An editorial in the BMJ that appeared shortly after thepoblica-tion of the Acheson report on p0mary health care in irnner London began swih the assertion, "Britain's inner cities have some of the worst social and medical probloms combined sith some of the poorest primary care services. This has been known for a long time ...."'1 The results of a survey among genralprctitioners in five healthd authorities in Greater Manchester, reported in the BM recently,, suggested, however, toat innsr London may be unique in the diversity and intensity of its problems of medical manpower. Contrary to popular belief, there is no concentration of isolated, elderly, single handed doctors with small lists and no lack of healoh centres and purpose built premises in the Manchester-Salford inher city partrership area. But therc is a striking concentration of doctors who qualified overseas and a bclow average proportion of young doctors. Although valuable for manpower planning, information about general pracitioners' characteistics tellus notling about how well or how poorly the services are organised. This paper, lherefore, considers whether the primary health care services in the Mantchesttt-Salford inner city partnership area are in general less well staffed, Iess well equipped, or less wellorganised lhan services in adjacent "outer" areas. Like the previous paper, this one dnwson data obtained from interviews conductedwilh 485 generalpractitioners in five health authorities in Greater Manchester in 1981.' Firstdy, the paper compares practices in the inner and outer areas on ccrtain organisational critera that general practitioner, control-that is, the employment of practice staff, clinical records and equipment, and thl use of appointments systems and deputising services. Secondly, it examines links between general practitioncrs, community nursts, and hopitals, hich are not controlled by general practitioners. Inside the practice STAF EMPLOYED BY PRATICE Inncr tty practices may be less well staffed than practices elsewhere.' Although virtually all practices in both the inner and outcr areas in Greatcr Manchester cmploy some staff, practices in the Manchestcr-Salford inner area employ a narrower rangc of staff than practices in the adjacent outer area (table I) In the inner area a high proportion of practices employ cleical staff only and a correspondingly low proportion havc practice managers-defined as someone who takes responsibility for any aspect of practicc organisation other than reception, filing, and corrospondence-and practice nurses.