Are restrictive NHS contracts of benefit in addressing health inequalities? An ecological evaluation of their value in the North East of England

Aim To determine if restrictive NHS contracts are of benefi t in addressing health inequalities in oral health, by using an ecological approach based upon an area measure of material deprivation. Methods Postcodes of patients seen under all the restrictive contracts (49) within the North East of England were identifi ed and matched to lower super output areas. The deprivation scores were identifi ed for each area using the Index of Multiple Deprivation 2007. The proportion of patients within each area was calculated and divided into deciles for England, from the most to the least deprived areas. Results 33,341 postcodes were identifi able from datasets supplied for the study in the North East; a further 4% were invalid. There was inequity in the distribution of patients, with proportionately more patients from the least deprived deciles and less patients from the more deprived deciles seen under the contracts. However, many thousands of patients identifi ed lived in the most deprived areas. Conclusions Restrictive contracts may be of benefi t in addressing health inequalities. PCTs need to carefully consider the impact of ending restrictive contracts on their local populations.