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The Inverse Care Law – QUB Ethics Society 8 Feb 2023 Dr Daniel Butler Academic General Practice Trainee @danielnbutler dbutler07@qub.ac.ukDr Julian Tudor-Hart The Inverse Care law: "The availability of good medical care tends to vary inversely with the need for it in the population served. This ... operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced."Introduction • General Practitioners working in deprived areas face unique challenges. • 50 years after the ‘Inverse Care Law’ paper, the health inequities gap is wide. • Workforce in high need areas is a challenge • Exposure & experience in any clinical setting is known to influence future career choices Inverse Care Law = “lack of time 242 to address needs” Standarised Mortality <75 years Physical Mental comorbidity 220 Consultations/1000 registered Funding/patient registered 194 187 178 171 173 161 156 155 148 148 146 134 139 127 125 116 123 120 120 115 113 114 116 115 107 102 105 105 107 100 102 110 100 101 106 1 most 2 3 4 5 6 7 8 9 10 most affluent deprived McLean G, Guthrie B, Mercer SW, Watt GC. (2015) General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland? BJGP, 65(641): 799-805 .Health inequalities = “shorter lives in poorer health” Barnett et al. (2012) Epidemiology of multi-morbidity and implications for health care, research, and medical education: a cross sectional study. The Lancet.Available at: http://www.ncbi.nlm.nih.gov/pubmed/22579043 Question Are medical students being deprived of learning placements in high need, deprived areas? Methodology • Mapped NI’s GP Practices as per deprivation indices • 323 Practices ranked in order of deprivation • A ‘deprived practice' defined as >50% registered patients living in the most deprived quintile of NI • Compared the deprivation rank of the 135 registered QUB Practices, against 323 national GP practices GPs at the Deep End = “blanket deprivation” Percatients in 20% Most Deprived Areasvation for Every NI Practice 100% 90% 80% 14% 70% 60% 50% 40% 30% 20% 10% 0% Northern Ireland's 319 Practices Northern Ir land's 319 GP PracticesResults • 10% of teaching practices were ‘deprived practices’, compared to 14% of Practices that met this criteria • 32% of ‘deprived practices’ across NI were undergraduate teaching Practices • 42% of ‘non deprived practices’ were undergraduate teaching PracticesConclusions • Whilst ‘deprived practices’ were marginally underrepresented the results were promising • Exposure to GP in deprived areas is an essential step to develop the future workforce • Ensuring all medical students are exposed to medicine in areas of deprivation is an important step to closing the health inequalities gapImplications & Considerations • Intentional placement of medical students should be considered • Limited to NI & QUB - shows good representation of ‘deprived Practices’ as teaching Practices • NI is more socio-economically deprived • Further exploration of why ‘non-deprived Practices’ are normal likely to be teaching Practices • New medical school in NI will increase Practice recruitment?What about GP training? • Postgraduate training practices had a statistically significant lower deprivation score • The proportion of training practices with blanket deprivation and higher levels of deprivation was underrepresented NI GPDeprivationScores 5.0 d i p D s M 4.0 s r S n t 3.0 i p D 2.0 t Key e f t None Training Avg Score 3.20 o M Training Avg Score 3.02 1.0 0 50 100 150 200 250 300  Each NI Practice (1- 319) ScoresSolution? • Universal Proportionalism? "Proportionate universalism is the resourcing and delivering of universal services at a scale and intensity proportionate to the degree of need." https://www.healthscotland.com/documents/24296.aspxSolution?