Domhnall MacAuley: General practice and social deprivation

Domhnall MacauleyA single naked bulb lights the room. Clothes hang over the radiator, there is a cot by the door, and a huge TV in the corner. Just a few worn chairs and a clapped out couch. Feet stick to the carpet. A world worn 19 year old and a distraught infant; hot, flushed, and dribbling. Kneeling in the squelchy dampness, knowing it’s vomit before catching the smell. Earache, temperature, miserable. No soft light movie sentimentality—home visit reality.  

Thank goodness for the “Deep End”—a project focusing on general practice in deprived areas of Glasgow.  The rest of the world has had to wake up to the reality of healthcare and social deprivation—inequality is about people. You cannot argue with quality in practice and QoF, for all its detractors, has had some clear benefits. But, it is a real struggle trying to achieve QoF in such deprived areas. People have other priorities. So, if you were a GP, would you practice in an area of deprivation? It means you have to work harder, probably earn less, and deal with lots of ancillary problems. I spoke to a Deep End GP, attending the recent RCGP City Heath conference, who was worried about continuity of care in poorer areas. The new big business model of general practice, with multiple less-than-full time GPs, may ensure practices make their targets and stay viable, but deprived patients with combined social and medical problems, who may benefit most from continuity of care, are less of a priority. Many doctors, reluctant to take on a partnership, serve their time as sessional doctors and move on. Add vertical outreach with heart failure nurses, COPD nurses etc, and those patients with multi morbidity may fall through the cracks.

There are committed hardworking and conscientious GPs working in these deprived areas who care greatly about their patients. The get on with it quietly, but are almost overwhelmed by the workload. We should encourage and reward them—not penalise them.

Domhnall MacAuley is primary care editor, BMJ.