The extent to which the NHS can contribute to reducing health inequalities, given that many of the causes of inequalities relate to other policy areas eg taxation, employment, housing, education and local government

  The determinants of patient health are more or less outside the control of the NHS as are several of the outcomes; evidence of healthcare providers compensating for this exists—such as length of consultation with GP and deprivation—where opportunity allows, GPs consult for longer with patients form deprived backgrounds.

The distribution and quality of GP services and their influence on health inequalities, including how the Quality and Outcomes Framework and Practice-based Commissioning might be used to improve the quality and distribution of GP services to reduce health inequalities;

  The history of resource allocation for general practice has an all too familiar ring of "inverse care law" ie disproportionate resources allocation to most well off communities. Sadly this continues to be the case right up to the present time—rather well demonstrated by the use of the square root formula in the new GP Contract.

The effectiveness of public health services at reducing inequalities by targeting key causes such as smoking and obesity, including whether some public health interventions may lead to increases in health inequalities; and which interventions are most cost-effective;

  Public Health intervention will only be effective if it is co-ordinated with other agencies and initiatives. We see several major morbidities which have their roots in life style choices exacerbated by other policy initiatives such as powerful supermarkets and food industries lobbying for ever expanding processed food markets, out of town developments necessitating use of cars and destroying local communities and selling off of recreational facilities to property developers by local authorities. Smoking ban is a welcome change of direction to this relentless process.

Whether specific interventions designed to tackle health inequalities, such as Sure Start and Health Action Zones, have proved effective and cost-effective;

  Unable to comment—through little feedback from any of my patients.

The success of NHS organisations at co-ordinating activities with other organisations, for example local authorities, education and housing providers, to tackle inequalities; and what incentives can be provided to ensure these organisations improve care

  As a GP, I am disappointed at the lack of effective cross-Sectoral working despite clear potential for this. Potential areas for collaboration include prescribing exercises, local recreational facilities and assistance with memberships local gyms for patients with significant disease laud such as diabetes, obesity, arthritis and so on. An anti obesity drug prescribed by the GP can cost up to £35/month which could more than cover assisted gym membership.

The effectiveness of the Department of Health in co-ordinating policy with other government departments, in order to meets its Public Service Agreement targets for reducing inequalities; and

  Unable to comment as I am not entirely sure about the details of the targets.

Whether the Government is likely to meet its Public Service Agreement targets in respect of health inequalities.

  Unable to comment as I am not entirely sure about the details of the targets

Dr Ramesh Bhatt, GP

January 2008