From the surgery to the surgeon: does deprivation influence consultation and operation rates?

BACKGROUND Concern about equity of access to health care has increased since the health care reforms implemented in the 1990s. Access to specialist health care is controlled by general practitioners; assessing and ensuring equity should therefore begin in general practice. AIM This study set out to determine whether there are socioeconomic differences in the relationship between expressed need for possible surgical intervention (consulting a general practitioner) and surgical provision. METHOD Information on the social class distribution of expressed need was obtained from the third national morbidity survey (1981-82) for 140,049 patients consulting a general practitioner. The conditions examined were: inguinal hernia, gallstones, tonsillitis, varicose veins, cataract and osteoarthritis. This expressed need was compared with the appropriate operation for all residents of North East Thames Regional Health Authority from January 1991 to July 1992 classified, according to area of residence, by the Townsend deprivation score. RESULTS The relationship between expressed need and provision by deprivation was concordant for some conditions, but discordant for others. For cataract and tonsillitis, there was an inverse U pattern between increasing deprivation and both patient consultation and operation ratios. For varicose veins, deprivation was associated with higher patient consultation and operation ratios. For hernia, gallstones and osteoarthritis, consultations increased with deprivation, but operation ratios were either unrelated to deprivation scores (hernia and gallstones) or decreased by deprivation score (hip operations). CONCLUSION There are marked socioeconomic differences in consultation ratios for these common conditions which may not be matched by operation ratios. For discordant comparisons, people in the most deprived quartiles were generally least likely to receive surgery despite being most likely to consult a general practitioner with symptoms. If validated, these findings have important implications for general practice and service providers.