Spatial access to healthcare: exploring the provision of local services

This thesis creates a context for exploring the provision of local healthcare services quantitatively, with particular focus on the application of spatial analysis and the use of geographic information systems (GIS). It focuses theoretically on the intersections between: health and medical geography; GIScience and spatially integrated social science; and social justice and spatial equity, elucidating the value of space and place in understanding patient registration with, and usage of, healthcare services. The practical elements of the thesis are based on patient registration data provided by Southwark primary care trust (PCT), and Hospital Episode Statistics from the NHS Information Centre. Focussing initially on primary care, registration with GP surgeries in Southwark is considered firstly from a normative perspective, and subsequently by employing a service area delineation approach. Profiling GP surgeries in this way enables an insight into patient registration behaviours, and sheds light on the challenges of implementing an agenda of patient choice as advocated by recent NHS white papers. The perspective of inpatient and outpatient care is also considered, given the increasing import of joined up provision in primary and secondary care. The thesis considers the linkage between the two service hierarchies, investigating utilisation of secondary care by patients. The value of this thesis derives from its relevance to the reform agenda that looks likely to radically reshape the NHS, the exploitation of patient registration data at individual level, novel use of classification, and the systematic application of spatial analysis across a range of scales