Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort

Background The ‘Five Year Forward View’ (NHS England) calls for a radical upgrade in public health provision. Inequalities in maternal health may perpetuate general patterns of health inequalities across generations; therefore equitable access to GP provision during maternity is important. This paper explores variation in GP consultation rates for disadvantaged mothers. Method Data from the Born in Bradford cohort (around 12,000 women), combined with GP records and GP practice variables, were modelled to predict GP consultation rates, before and after adjusting for individual health and GP provision. Results Observed GP consultation rates are higher for women in materially deprived neighbourhoods and Pakistani women. However these groups were found to consult less often after controlling for individual health. This difference, around one appointment per year, is ‘explained’ by the nature of GP provision. Women in practices with a low GP to patient ratio had around 9 fewer consultations over the six year period compared to women in practices with the highest ratio. Conclusions Equitable access to GP services, particularly for women during the maternal period, is essential for tackling deep-rooted health inequalities. Future GP funding should take account of neighbourhood material deprivation to focus resources on areas of the greatest need.