GPs at the Deep End

These 12 articles¹ and Watts'² concluding editorial have been inspirational, and for us, like others,³ have helped validate our experience over a professional lifetime of serving in a deprived post-war peripheral council estate where there were ‘very few easy cases’.⁴ We recognise each characteristic cited by Watts, as being a true reflection of issues faced by all patients at the Deep End, and the teams who serve them.

Watts et al convincingly make the case, again, for additional healthcare resources to deal with the number, severity, and complexity of health and social problems at the Deep End, that are difficult to address with standard resources and in standard consultation times.⁵ Despite the shorter life expectancies, and many more years in poor health before death, endured by Deep End patients, any additional healthcare resources directed to Deep End populations do not reflect the additional, potentially preventable, morbidity and premature mortality.

An answer to this mismatch of need and resource is to engineer longer consultation times in deprived areas, either with doctors, or with nurses able to handle the complexity of multiple morbidity, and this model would fit the opportunistic nature of the work. This requires political will and professional support, rather than opposition.⁶ It is telling that the Black Report, in 1980, was released in small numbers on a Bank Holiday weekend, and that this important series of articles from GPs at the Deep End has, to date, generated only three letters to this journal. The blind spot to which Watts refers is real. His point that Tudor Hart's Inverse Care Law is a man-made construct, that restricts access to care based upon need, is well made. The point, as he says, is not that poor areas get bad GPs while rich areas get good ones, but that good GPs in poor areas are prevented from maximising what they could do by failure of provision of the resource that would give the deprived ‘an average chance of health’. The issue is not doctor workload, but resource to reach all the potentially treatable morbidity.

Twenty-one years ago we wrote a series of articles for this journal (they appeared in Connexions) about the need to target resources to the ‘forgotten areas of deprivation’ to give our patients an ‘average chance of health’.⁷ Over 65 years, between us, of service within socio-economic deprivation, it was our clear experience that advocacy on behalf of the health resource needs of patients, needs to be a constantly repeated teaching theme. Resource providers start out not understanding, learn in dialogue, then move on and the educational process has to start all over again.

The mutual support that Deep End group participants have experienced is relevant for Deep End workers everywhere. The involvement of policy advisers from the Scottish Government Health Directorate is important. We look forward to hearing more about the trajectory of this initiative. As Watt says: ‘addressing the Inverse Care Law is not rocket science’, but it is vital to the health of deprived patients. Would that a similar group could establish itself south of the border.