The relationship between use of NHS Direct and deprivation in southeast London: an ecological analysis

Background Little is known about the utilization of NHS Direct by disadvantaged groups, in spite of the service aiming to be 'accessible to all'. This study investigates the relationship between use of NHS Direct and deprivation in one predominantly disadvantaged area. Methods Ward-level call rates to NHS Direct South East London over a 6 month period were calculated using postcode data. Jarman and Townsend scores were used as a proxy of deprivation in each ward. We performed negative binomial regression to investigate the relationship between deprivation score and rate of calls to NHS Direct. Results There was a significant, non-linear (quadratic) effect of deprivation score on call rates; call rates were lower in both the most affluent and most deprived wards. Conclusion Calls to NHS Direct rise with increasing deprivation until, at extreme levels of deprivation, they subsequently decline. This challenges assumptions that NHS Direct is not utilized in deprived areas.