GP mythbuster 90: Population groups

In October 2021, we introduced a simpler approach to rating your practice. See changes for flexible regulation: equality impact assessment.

We report our findings relating to the practice population groups in the detailed key question sections, we do not give an individual rating for each population group.

What this means for GP practices

We still look at the quality of care for the population groups to assess how well practices are meeting their specific needs. But our view of patients, or the care they receive, is not restricted to these specific groups.

We recognise that practices may not organise their approach to patient care according to our population groups. They may use different categories to classify and assess patients in a way that allows them to serve their local patient population effectively.

The NHS England GP Contract includes an equalities and health inequalities statement. It also sets out the expectations for GP practices regarding their local population.

Inequalities in health and care

To deliver our strategic ambition to tackle inequalities in health and care we have developed measures to ensure we focus on specific areas. When we assess and report on quality, we will use the summary phrase ‘people more likely to have a poorer experience of care’. This covers people who are more likely to have poor access, experience, and outcomes in health and social care.

People more likely to have a poorer experience of care

We have identified these groups of people as:

• people who are aged 80 and over
• looked after children and care leavers
• people with a learning disability or autistic people
• people with severe mental ill health
• Military veterans
• disabled people with physical or sensory impairments
• people with dementia
• people with multiple long-term conditions
• people from Black and minority ethnic groups
• trans, non-binary and intersex people
• Inclusion health groups of socially excluded people:
• those in the UK immigration system
• homeless people and rough sleepers
• Gypsies, Roma and Travellers
• people who sell sex
• recently released prisoners
• nomadic people
• survivors of modern slavery and human trafficking
• lesbian, gay and bisexual people
• people living in areas of deprivation
• people providing unpaid care to family or friends who are older, ill or disabled people (carers)
• people who have experienced domestic abuse, including children from families where domestic abuse has occurred
• people who are overweight or obese

How we define and assess population groups

People who are more likely to have a poorer experience of care can be included in any of the population groups that we look at in NHS GP services. These are:

• Older people
• People with long-term conditions
• Families, children and young people
• Working age people (including those recently retired and students)
• People whose circumstances may make them vulnerable
• People experiencing poor mental health

These population groups are not mutually exclusive. So, a person may be included in more than one group at the same time.

By looking at services provided for each of these groups within the local practice population, we can consider care and outcomes for everyone. This includes those who may need more support.

We can also provide information to the public about local services that are relevant to them.

Older people

This includes:

• all people in the practice population aged 75 and over
• people who have good health and those who may have one or more long-term conditions, both physical and mental
• people living at home, in a residential care home or a care home with nursing, where practices provide general medical services or personal medical services to them.

This focuses on how the practice develops a proactive and personalised programme of care and support. This should be tailored to the needs and views of older people registered with them.

The NHS England Personal Medical Services Agreement includes details of expectations for caring for people aged over 75 years.

People with long-term conditions

These people have an ongoing health problem that cannot be cured. Long-term conditions can be managed with medicines and other therapies. Some examples of long-term conditions include:

• diabetes
• cardio-vascular disease
• musculoskeletal conditions
• chronic obstructive pulmonary disease (COPD)
• long-term neurological disorders (motor neurone disease, multiple sclerosis, epilepsy)
• HIV

This does not include:

• people with long-term conditions aged over 75 (they are included in‘older people’)
• children or young people aged under 18 who have long-term conditions (they are included in ‘children and young people’).

Families, children and young people

This group includes:

• expectant and new parents. This includes pre-natal and antenatal care and advice, where a practice provides this.
• babies
• children and young people. We will use the legal definition of a child, which includes young people up to their 18th birthday

We consider the specific services a practice provides, including whether it is registered for the regulated activity of maternity services,. This affects the level of services a practice provides to parents.

Working age people, including those recently retired and students

This group includes:

• all working age people in the practice population
• those recently retired (up to the age of 75)

This is whether or not they are in employment. For example, it includes students aged 18 and over.

It focuses on how working age people and students can access appointments and services at the practice.

People whose circumstances may make them vulnerable

This may include many different groups whose particular circumstances may make it harder for them to access primary care. Some of these people may also be living in circumstances that make them vulnerable.

The groups that our assessments will focus on will depend on the practice’s:

• population
• own assessment of which groups of patients are more vulnerable and may find it particularly difficult to access primary care. However, we expect GP practices to consider all the people more likely to have a poorer experience of care and to always include:
  • people with a learning disability
  • people at the end of life
  • homeless people.

Practices should determine which groups of people are relevant in their practice population.

This population group focuses on poor access to GP services generally, rather than physical access to a practice for an appointment. It includes being able to register with a practice, book appointments and receive services. See information on:

• Patient registration
• Looking after homeless patients in general practice
• Registration and treatment of asylum seekers and refugees.

People experiencing poor mental health (including people with dementia)

This population group includes people experiencing poor mental health across a range of different conditions. This may range from depression, including postnatal depression, to severe and enduring mental illnesses, such as schizophrenia.

The group also includes people who have dementia.

When we inspect

We will ask you to show us evidence to demonstrate how your practice meets the needs of the specific population groups. We use these Regulations when we review if the practice is safe, effective, caring, responsive, and well-led.

We may not assess every regulation. If there are concerns relating to providing care to individual groups of people within the local population we would use:

• Regulation 9 (Person-centred care)

We will ask:

• Do the services provided reflect the needs of the population served?
• Does care and treatment support and meet the needs and preferences of the local population?
• Do the services provided:
  • offer flexibility, choice and continuity of care
  • take account of people’s strengths, abilities, aspirations, culture and unique backgrounds?
• How does the practice deliver services, make them accessible, and co-ordinate them to take account of the needs of different people? This includes those:
  • with protected characteristics under the Equality Act 2010
  • more likely to have a poorer experience of care.