Where did all the GPs go? Increasing supply and geographical equity in England and Scotland

Objectives: To examine the effect on geographical equity of increases in the total supply of general practitioners (GPs) and the ending of entry restrictions in 2002 and to explore the factors associated with the distribution of GPs across England. Methods: Calculation of Gini coefficients to measure geographical equity in GPs per 100,000 population in England and Scotland. Multiple regression of GPs per capita and change in GPs per capita on demographics, morbidity, deprivation and measures of amenity in English Primary, Care Trusts (PCTs). Results: Equity in England rose between 1974 and 1994 but then decreased, and in 2006 it was below the 1974 level. After 2002, England had a greater percentage increase in GP supply than Scotland and a smaller increase in inequity. The level of GP per capita supply in 2006 was positively correlated with morbidity and PCT amenity, and negatively correlated with unemployment and poor air quality. The increase in per capita supply between 2002 and 2006 was not significantly associated with morbidity, deprivation or amenities. Conclusions: Reducing geographical inequity in the provision of GPs requires targeted area level policies.