Does shortage of general practitioners matter? Life expectancy in English general practices

Background: England has insufficient GPs. Access and continuity are declining. Aim: To investigate whether practice characteristics are associated with life expectancy of practice populations. Design and Setting: Cross-sectional ecological study of female and male life expectancy 2015-19. Method: Selection of independent variables was based on conceptual frameworks describing general practice’s influence on outcomes. Sixteen non-correlated variables were entered into multivariable weighted regression models: population characteristics (Index of Multiple Deprivation, region, % white ethnicity, % on diabetes register); practice organisation (total NHS Payments to practices expressed as payment/registered patient, full time equivalent [FTE] fully qualified GPs, trainee GPs, advanced nurse practices, other nurses and receptionists/1000 patients); access (% seen on the same day); clinical performance (% aged 45 or older with BP checked, % with COPD vaccinated against influenza, % with diabetes in glycaemic control, % with CHD on anti-platelet therapy); and the therapeutic relationship (% continuity). Results: Deprivation was strongly negatively associated with life expectancy. Regions outside London, and white ethnicity were associated with lower life expectancy. Higher payment/patient, FTE fully qualified GPs/1000 patients, continuity, % with COPD having influenza vaccination, and % with diabetes with glycaemic control were associated with higher life expectancy; % being seen on same day was associated with higher life expectancy in males only. Percentage 45 years or older with a BP check was a negative predictor in females. Conclusion: The numbers of GPs, continuity, and access are declining, and it is worrying that these features of general practice were positively associated with life expectancy.