TY - JOUR T1 - Commentary: What is the NHS for? JF - British Journal of General Practice JO - Br J Gen Pract SP - 727 LP - 728 DO - 10.3399/bjgp08X342381 VL - 58 IS - 555 AU - Graham CM Watt Y1 - 2008/10/01 UR - http://bjgp.org/content/58/555/727.abstract N2 - Asthana and Gibson challenge ‘the conventional wisdom of inverse care’.1 Analysing primary care data from England, they show that the mismatch between need and resource, resulting in inequitable access to health care, applies as much to the health needs of older populations as deprived populations, and is especially the case in populations that are both older and deprived. This is an important and, in places, a contentious paper, raising issues that may help to clarify what is meant by inverse care and how it should be addressed.Readers with long memories may be reminded of the Jarman deprivation score, which was pragmatically constructed to reflect what makes GPs busy, and thus included a measure of the numbers of older patients served. Concern about workload is also familiar to the GP negotiators of the British Medical Association whose traditional position has been that GPs should be similarly resourced and rewarded for being busy. However, there is more to the NHS than paying doctors, and keeping doctors busy is no guarantee of social justice.Asthana and Gibson observe that while almost everyone seems familiar with the ‘inverse care law’, there is little precise understanding of what it is and how it should be addressed. Tudor Hart's original paper contained few data and was principally concerned with the effects of market forces.2 More recent discussion has begun to tease out different definitions of access, according to structure, process, and outcome3 … ER -