GPs, patients, and the distance between them

摘要

The issue of coherent catchment areas for primary care is raised again by Murray and colleagues in this week's journal (p 100). The problem can be viewed from two perspectives: the distance that the patient is from the doctor and the distance that the doctor is from the patient. For most people the convenience of the nearest surgery is the main determinant of where they register. Nevertheless, many go further afield, and historic factors may be important in their choice. When they move, those in urban areas often remain with the devil they know—"the desire to maintain a link with a doctor known to the family . . . appears to be stronger than any wish to minimise the distance travelled to the practice premises." The availability of a woman doctor, and, for patients from ethnic minorities, doctors from their own cultural group, may also be important. Since 1948, when a salaried component was added to the simple equation between capitation and income, there has been little evidence that doctors retain migrants or accept allcomers for financial reasons. The majority of patients on most urban general practitioners' lists live within the practice's catchment area. This limits unnecessary travelling, facilitates care with local teams, and ensures that local populations do not lose out to more distant but mobile patients. But maintaining the right of patients to choose within limits seems a desirable option and one that services should be capable of accommodating.