Consultant outreach, 1991 to 1998. An update and extension on its distribution in Scotland.

Abstract

Objective: To assess the extent and distribution of consultant outreach in Scotland between 1991 and 1998.

Design: The paper has three parts. First a description of the trends in consultants and consultant activity provides the background. This is followed by the results of an update of the 1991 survey of all health centres in Scotland and its extension to all GP premises considered suitable to hold consultant clinics. Finally, binary regression analysis of outreach is used to test the importance of total list size, distance to alternative provision and deprivation. Fourteen of the most common consultant specialties are studied.

Setting and subjects: Scotland-wide data on consultants and consultant activity using annual data over the 1990s; and a Scotland-wide survey of 231 health centres and 312 GP premises over the period July to December 1998.

Results and conclusions: Consultant full time equivalents (ftes) increased and, with minor exceptions, consultant activity did so too. In respect of outreach, the increase was largely at GP premises and for psychiatry. For only two specialties of the fourteen studied, obstetrics and general psychiatry, could outreach be considered important. Such outreach provision as was made went where the total list size was largest and alternative provision farthest distant. The evidence that deprivation had an influence on outreach varies with specialty and is qualified.