July 14, 2020
In at the Deep End
We hear a lot about the health inequalities in this country but unless you work in the health system I suspect, like me, you’ll only have a vague idea about how these inequalities actually manifest themselves. GP’s are at the front line of primary care and GPs with practices in the most disadvantaged communities probably will have some pretty well informed ideas about what’s needed. The Deep End Group – a national network of these GPs – has published a short report highlighting what they think is needed to improve health in these communities – and it’s not more GPs.
GPs working in the most deprived communities in Scotland are calling for more practices to have community workers and money advisors in their teams in preparation for the economic and mental health shocks of covid-19.
The Deep End Group, which brings together family doctors in the most deprived communities in Scotland, says major changes are needed as part of a “a once in a generation opportunity to reset the NHS in Scotland”.
A new report has highlighted the impact of the pandemic, with one GP warning of increased drug use and giving out more emergency kits to reverse drug overdoses “than I care to count”.
Another doctor revealed that despite the move to holding more consultations online, only around 30% of video appointments worked due to technology issues and language barriers.
Dr Anne Mullin, a GP in Govan, who is chair of the Group and a contributor to the report, told healthandcare.scot: “We cannot leave behind our patients who struggle to access IT systems, patients who live in poverty and financial insecurity who will disproportionately account for ‘Years of Life Lost’ during the pandemic.
“Child poverty is increasing and we must do more than pay lip service to that and other adverse consequences of the pandemic.”
Practitioners in Glasgow and Edinburgh were asked to report and reflect on their experience of the covid-19 pandemic during May 2020.
One of the key points of the report is a call to double the number of community link workers, who can refer patients on to support in communities.
In 2016 the SNP promised to recruit 250 more to work in practices in the most deprived areas.
But currently only half of practices in the least well-off areas have one, according to the report.
One GP quoted in the report said their link worker had been “invaluable” and had helped a “huge range” of patients, including by referring people on to welfare advice.
“I really worry about the financial impact of the pandemic and feel there will be an increasing need for Deep End populations across Glasgow and Scotland to have a practice-based Financial Support Worker,” the GP added.
Meanwhile just 17 of Glasgow’s 75 most deprived practices have money advice workers who can encourage and support patients to apply for benefits they are entitled to.
This is despite evidence that suggests the average gain per claimant can be more than £7000, while a previous evaluation found patients received the equivalent of £27 in financial gains for every £1 invested.
General practice moved “overnight” to a new way of working with less bureaucracy, the report says, and consultations increasingly done by phone or video.
But there are concerns about “missing patients” who are being left behind.
One doctor quoted in the report said: “Only 30 percent of my attempted video consultations worked, often due to older smart phones that did not have new technology and thus couldn’t be accessed.
“They had to be seen face to face or by phone. I gave up on trying to do video consulting for patients who require translators.”
Others warned of the effects lockdown was having on wider wellbeing, with a rise in mental health problems and drug use.
One medic said “almost every substance misuse consultation” in the last three weeks had revealed increased drug use.
“I have given out more emergency opiate reversal kits than I care to count. Some of these patients have young children,” they added.
The report says many of the people experiencing mental health problems because of covid-19 will be seen by their GPs, often because they will not meet the threshold for referral to specialist services.
Dr Mullin added: “General practice has emerged from this first phase of the covid pandemic by adapting to new ways of working and many of the changes will be permanent.
“Deep End GPs have outlined in [the report] how practices strengthened connections within GP clusters, with other professional colleagues in the community and the 3rd sector, such as Links Workers, to blur the boundaries of working and provide optimal patient care.
“The importance of leadership, communication, coordination and teamwork in general practice is emphasised in the report with practical solutions to the ‘what next’