The influence of geography on uptake of plastic surgery services - analysis based on bilateral breast reduction data

The hub-and-spoke model was introduced in the National Health Service (NHS) with the goal of providing equitable access to health care for all. This study uses bilateral breast reduction (BBR) surgery to assess the success of this model in delivering equity of access for plastic surgery within a publicly funded health-care system. This study also assessed the effect of socioeconomic deprivation on patients seeking BBR. The hospital records were used to identify all patients who underwent BBR at the St. John's Hospital between 1996 and 2005 (N=1081). Patients living outside the catchment area were excluded. Realistic travel distances and times to the hospital and clinics were calculated using patients' postcodes and geographic information systems (GIS) network analysis. Carstairs deprivation scores were obtained for the residential postcode of each patient. The main findings of this study are (1) accessibility to a plastic surgery clinic is an important factor in determining whether an eligible female patient undergoes BBR and (2) most deprived parts of the catchment area accounted for a significantly greater proportion of patients.