INTRODUCTION
The negative effect of socioeconomic deprivation on health has been an important theme for primary care for several decades. Efforts to draw attention to this problem and redress inequalities have been actively supported by the RCGP, and have led to much good work.1 However, I believe that the role of deprivation in both service planning and medical education requires review.
The NHS was founded in 1948 on an expressed egalitarian ethos. However, within a few years of its inception, health professionals began voicing concern that despite overall rising prosperity and improving population health, poorer people were still disadvantaged in accessing this resource. In 1971 Julian Tudor Hart published his influential paper ‘The Inverse Care Law’ in which he argued that, even within the NHS, market forces that disadvantaged the poor existed.2 Another milestone occurred in 1983 when Brian Jarman published a scoring system for identifying areas of deprivation that had an adverse impact on GPs workload,3 giving the topic further impetus.
REDISTRIBUTION — A FLAWED STRATEGY
The medical profession, and the wider community, has a moral duty to look after less fortunate citizens,4 and a degree of wealth redistribution appears a reasonable strategy. Indeed, for many years and under successive governments, healthcare funding has been preferentially diverted towards areas of deprivation, and is a stated aim of the current government.5 For example, from 1990 until the start of the GMS2 contract, GPs working in deprived areas were given extra payments under the said Jarman index, and not conditionally to demonstrating improved outcomes. Yet inequalities of income …