Editor—Target payments to health authorities and primary care trusts are based on the number of people recorded as living in the area in the national census. Discrepancies between this figure and the number recorded as being on general practitioners' lists puts pressure on health authorities to have patients removed from lists if the authorities believe that they no longer live at the address at which they are registered.
Our practice serves a population that includes some 60% people of Asian or African origin. A considerable proportion are not fluent in English; some have arrived in Britain within the past three years, and we have about the expected number of people with dementia or psychosis. We suspected that these factors might limit their ability or willingness to take part in the census.
Over three weeks we asked consecutive or nearly consecutive patients seen at our surgery or the adults who accompanied them whether they were included in the census. We have recorded the findings. We also recorded whether these patients had come to Britain in the past three years, whether they were fluent in English, and whether they had an appreciable mental health problem. The table shows our findings.
Although patients attending our practice may not be representative of the population as a whole, 23% of those asked either stated that they were not included in the census or did not know whether they were. We conclude that the census greatly underestimates the number of people resident in an area such as ours, to the detriment of funding of local NHS services.
We found that people under-represented in the census were particularly those recently arrived in Britain, those least fluent in English, and those with mental health problems. These are some of the people who can most benefit from services in general practice. We have an impression that living in multioccupancy accommodation such as “bedsits” also leads to under-representation in the census, but we did not include this factor in the survey.
Table.
Patients seen over three weeks who were or were not included in census
| Included in census (A) | Not included in census (B) | Significance | |
|---|---|---|---|
| Total | 151 | 44 | |
| Came to United Kingdom in past 3 years | 34 | 26 | P<0.001* |
| Fluent in English | 121 | 16 | P<0.001* |
| Mental health problem | 6 | 7 | P<0.01† |
| Male | 57 | 20 | NS |
| Mean (SD) age (years) | 47.1 (21.5) | 40.9 (23.3) | NS |
A/(A+B)=77%. *zc test for proportion. †Fisher's exact test.