Professor Susan Smith:

We are a group of GPs working in disadvantaged areas, but we represent a larger group across the country. We have called our group Deep End Ireland which has been modelled on a similar project in Scotland that has been running for a number of years and is called General Practice at the Deep End. We will start by presenting some of the evidence which highlights the poorer health outcomes experienced by patients living in deprived or disadvantaged areas. We will then present a description of what is called the inverse care law and a related case history example. We will also offer some potential policy solutions, following which we will be happy to address questions.

Patients living in the most deprived areas have significantly poorer health outcomes than those living in the most affluent areas. They have lower life expectancy and higher mortality rates at all ages. When they get cancer, they tend to present later and are twice as likely to die from it. Not only are they more likely to die prematurely, they also have higher rates of chronic conditions and are more than twice as likely to have heart disease and be at high risk of having a stroke. They are also more likely to have multiple chronic conditions referred to as multimorbidity which occurs ten to 15 years earlier among the most deprived members of the population. GPs working in the most deprived areas tend to have approximately 40% more patients with multimorbidity than GPs working in more affluent areas. This is further complicated by the fact that patients living in deprived areas are more than twice as likely to have a combination of physical and mental health problems, with rates of 113 per 1,000 patients compared to 52 per 1,000 patients in the most affluent areas. These patients often struggle to manage acute and chronic conditions while facing other social and financial pressures.

I draw the committee's attention to a graph we have circulated which highlights the evidence which underpins the difference in health outcomes. Along the bottom line, one can see No. 1 represents the most affluent populations, down to No. 10 which represents the most deprived. The red line indicates the level of physical and mental co-morbidity, while the blue line indicates the level of standardised mortality. The black line is fairly flat right across the different groupings. It represents the flat distribution of funding, despite the clearly different needs among the most deprived populations. Complex multimorbidity is much more common in practices in deprived areas and reflected in higher consultation rates, but it does have ramifications throughout the health service. The 10% of patients with four or more chronic conditions account for 34% of unplanned emergency admissions and 47% of preventable unplanned admissions.

While we acknowledge the impact of wider social inequality on poorer health outcomes, we are going to focus on the challenge and opportunity to provide GP care for the most deprived patients. This GP care is delivered within the context of what has been referred to as the inverse care law. Dr. McGinnity will explain this further and present an anonymised case history that illustrates the challenges and lost opportunities.