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. 2013 May;63(610):e339-44.
doi: 10.3399/bjgp13X667204.

Are there enough GPs in England to detect hypertension and maintain access? A cross-sectional study

M John Bankart  1 , Mohammed S Anwar, Nicola Walker, Arch G Mainous 3rd, Richard Baker
Affiliations

Are there enough GPs in England to detect hypertension and maintain access? A cross-sectional study

M John Bankart et al. Br J Gen Pract. 2013 May.

Abstract

Background: Fewer patients are recorded by practices as having hypertension than are identified in systematic population surveys. However, as more patients are recorded on practice hypertension registers, mortality from coronary heart disease and stroke declines.

Aim: To determine whether the number of GPs per 1000 practice population is associated with the number of patients recorded by practices as having hypertension, and whether patients' reports of being able to get an appointment with a GP are associated with the number of GPs and the number of patients recorded as having hypertension.

Design and setting: Cross-sectional study of available data for all general practices in England for 2008 to 2009.

Method: A model was developed to describe the hypothesised relationships between population (deprivation, ethnicity, age, poor health) and practice characteristics (list size, number of GPs per 1000 patients, management of hypertension) and the number of patients with hypertension and patient-reported ability to get an appointment fairly quickly. Two regression analyses were undertaken.

Results: Practices recorded only 13.3% of patients as having hypertension. Deprivation, age, poor health, white ethnicity, hypertension management, and the number of GPs per 1000 patients predicted the number of patients recorded with hypertension. Being able to get an appointment fairly quickly was associated with the number of patients recorded with hypertension, age, deprivation, practice list size, and the number of GPs per 1000 patients.

Conclusion: In order to improve detection of hypertension as part of a strategy to lower mortality from coronary heart disease, the capacity of practices to detect hypertension while maintaining access needs to be improved. Increasing the supply of GPs may be necessary, as well as improvements in efficiency.

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Figures

Figure 1
Figure 1
Hypothesised model of population and primary care characteristics influencing detection of hypertension (unbroken line) and the impact of the amount of detected hypertension on access (broken line). Detection of hypertension is associated with mortality from heart disease and stroke.,
See this image and copyright information in PMC

Comment in

  • Are there enough GPs in England to detect hypertension and maintain access?
    A'Court C, Atherton H, Dalton A, Fleming S, Hirst J, Nunan D, Selwood M, McManus RJ. A'Court C, et al. Br J Gen Pract. 2013 Jul;63(612):346-7. doi: 10.3399/bjgp13X669103. Br J Gen Pract. 2013. PMID: 23834865 Free PMC article. No abstract available.
  • Authors' response.
    Baker R, Bankart MJ, Anwar MS, Walker N, Mainous A 2nd. Baker R, et al. Br J Gen Pract. 2013 Jul;63(612):347. doi: 10.3399/bjgp13x669112. Br J Gen Pract. 2013. PMID: 23991447 Free PMC article. No abstract available.

References

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    1. NHS Employers . Investing in general practice The New General Medical Services contract. Leeds: NHS Employers; 2003. http://www.nhsemployers.org/SiteCollectionDocuments/gms_contract_cd_1302... (accessed 12 Mar 2013).
    1. Levene LS, Baker R, Bankart MJG, Khunti K. Association of features of primary care with coronary heart disease mortality. JAMA. 2010;304(18):2028–2034. - PubMed
    1. Levene LS, Bankart J, Khunti K, Baker R. Association of primary care characteristics with variations in mortality rates in England: an observational study. PLOs One. 2012;7(10):e47800. - PMC - PubMed
    1. Department of Health . Putting prevention first Vascular checks: risk assessment and management. London: DoH; 2008.

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