Thank you for this. I am a GP, and I worked in a deprived area of Manchester for many years, until I "burned out", eventually leaving the practice in 2012, when I was 60. After a break, I started working part-time for an out of hours GP service (in a different Manchester area), which I still do (but very part time now!) As I am no longer a GP principal (that is, having my own practice), I am less familiar with the organisation and funding of GP practices these days (it has always changed every few years) but I can see that things have been getting worse for my colleagues in ordinary practice. It will not be news to anybody that poverty has increased since 2012, and we know that the number of GPs has fallen, while the number of patients has risen. Often, in out of hours work, we see patients who have been unable to see their GP in ordinary hours because of work pressures, yet now it appears to be more difficult for GPs to get jobs, which is insane! Many of them turn to out of hours work (so there is less demand for me personally). But the workload still rises.
And the inverse care law - I did hear about it at medical school, by the way, though I graduated in 1976 - still operates. Out of hours services operate from one centre per area, with visits only for housebound patients. So further to go, and difficult for patients without their own transport, especially overnight and at weekends. Our organisation is unusual in that we will fund transport for patients who can't afford to get to us, but we don't get funding for that, so we can't do it for lots of people. And it is obvious to me that far fewer patients from deprived areas get through the 111 gateway - and probably far fewer call in the first place. We are so busy anyway that it is easy to overlook this, but it is obvious if you look. So, yet again, deprivation means you get less care, from more stressed clinicians.
I love being a GP, and often feel guilty that I'm not "on the front line" any more. Stupid of me, I know! But in the present climate, where it is easier for a patient to blame their GP for not being able to see them in their need, than to understand why they can't, General Practice needs all the support it can get. So thank you!
This article gave me insight into what goes into becoming a GP and what motivates doctors to specialise in general practice. As a patient whose medical needs have changed in ways that mean I have to engage with my local practice more often, and the frustrations I feel as a result of that, I don't spend much time thinking about what it's like for the doctors.
As Mary alludes in her comment, GPs have been struggling with overwork and lack of support for a long time. A GP at the surgery my parents attended died by suicide 16 years ago because of the difficulties of managing the practice, trying to recruit another GP as a partner and trying to recruit a practice manager. The practice isn't in a deprived area. She was, as the phrase goes, a popular and much loved doctor, because she was good at her job and wanted to do it well. How much worse it must be for GPs working in worse off areas.
While it's great that the organisation featured in this article is doing something practical to support GPs, it doesn't go far enough. Every GP needs this additional training and support. So do their frontline staff who often behave like gatekeepers and often lack a consideration of why people might not attend and might forget to cancel appointments, might have complex medical needs requiring longer than a 10 minute appointment, and might not have lives that fit with the systems put in place to book appointments. From personal experience as a patient at a busy GP surgery covering a large area with mixed socioeconomic groups, while I understand what's at the back of their approach to patient management, I end up feeling that I am a nuisance, which puts me in a certain frame of mind when I go to an appointment, which makes it harder to get the help I need. And I'm a comfortably off, articulate woman with minimal pressures in my life.
I'm not a healthcare worker, but it feels like the NHS can't currently do what it was set up to do, because successive governments have chosen not to invest in it. Society has changed, too. I guess programmes like the one in this article are better than nothing, but they barely scratch the surface.
First, the quality of articles since I subscribed leaves many "nationals" way behind. Why? Because you are not afraid to make an article comprehensive. The nationals take the latest press release and tinge it with their own political flavour and out it pops. Your articles are thorough, the writing good (the one on youth football in Stockport was outstanding), and your investigative work would please Mr H Evans.
Second, this article depressingly exposes once again the immense problems that exist for the poor and vulnerable and the brave souls who try to help with inadequate resources. Health, education, mental health services, housing. It begs the question where does all the money go that governments spend? What are the differences between Manchester and London in terms of per capita spend on health care? Also bear in mind that in the more affluent parts of the country private healthcare is far more common than it will be (I'm assuming -shouldn't do that) in Manchester.
Levelling up! I wonder how much of a fraud that has been? And I wonder, does any political party have half an answer? I don't think so. Politicians talk the talk about this new law or another...it would be rather nice if government could deliver services. They don't at the moment.
Just heard Joshi on Radio 4 Broadcasting House. Well done Joshi. They loved your phrase “Traffic Pigs”. Great hearing Tina Brown big you up on national radio. I enjoy your work too.
A young person I know is a GP in a deprived area, she says she spends very little time practicing medicine and a lot of time on the phone seeking help from social services, drug addiction centres, refuges for battered women etc.
She is in her early 30s but the stress of the job has resulted in her reducing her working week to 3 days.
Thank you for this. I am a GP, and I worked in a deprived area of Manchester for many years, until I "burned out", eventually leaving the practice in 2012, when I was 60. After a break, I started working part-time for an out of hours GP service (in a different Manchester area), which I still do (but very part time now!) As I am no longer a GP principal (that is, having my own practice), I am less familiar with the organisation and funding of GP practices these days (it has always changed every few years) but I can see that things have been getting worse for my colleagues in ordinary practice. It will not be news to anybody that poverty has increased since 2012, and we know that the number of GPs has fallen, while the number of patients has risen. Often, in out of hours work, we see patients who have been unable to see their GP in ordinary hours because of work pressures, yet now it appears to be more difficult for GPs to get jobs, which is insane! Many of them turn to out of hours work (so there is less demand for me personally). But the workload still rises.
And the inverse care law - I did hear about it at medical school, by the way, though I graduated in 1976 - still operates. Out of hours services operate from one centre per area, with visits only for housebound patients. So further to go, and difficult for patients without their own transport, especially overnight and at weekends. Our organisation is unusual in that we will fund transport for patients who can't afford to get to us, but we don't get funding for that, so we can't do it for lots of people. And it is obvious to me that far fewer patients from deprived areas get through the 111 gateway - and probably far fewer call in the first place. We are so busy anyway that it is easy to overlook this, but it is obvious if you look. So, yet again, deprivation means you get less care, from more stressed clinicians.
I love being a GP, and often feel guilty that I'm not "on the front line" any more. Stupid of me, I know! But in the present climate, where it is easier for a patient to blame their GP for not being able to see them in their need, than to understand why they can't, General Practice needs all the support it can get. So thank you!
Another great example of why The Mill matters. The article held my attention to the very end.
As an affluent healthy 73-year old who grew up in a slum, I am acutely aware of the health divide in our society.
This article gave me insight into what goes into becoming a GP and what motivates doctors to specialise in general practice. As a patient whose medical needs have changed in ways that mean I have to engage with my local practice more often, and the frustrations I feel as a result of that, I don't spend much time thinking about what it's like for the doctors.
As Mary alludes in her comment, GPs have been struggling with overwork and lack of support for a long time. A GP at the surgery my parents attended died by suicide 16 years ago because of the difficulties of managing the practice, trying to recruit another GP as a partner and trying to recruit a practice manager. The practice isn't in a deprived area. She was, as the phrase goes, a popular and much loved doctor, because she was good at her job and wanted to do it well. How much worse it must be for GPs working in worse off areas.
While it's great that the organisation featured in this article is doing something practical to support GPs, it doesn't go far enough. Every GP needs this additional training and support. So do their frontline staff who often behave like gatekeepers and often lack a consideration of why people might not attend and might forget to cancel appointments, might have complex medical needs requiring longer than a 10 minute appointment, and might not have lives that fit with the systems put in place to book appointments. From personal experience as a patient at a busy GP surgery covering a large area with mixed socioeconomic groups, while I understand what's at the back of their approach to patient management, I end up feeling that I am a nuisance, which puts me in a certain frame of mind when I go to an appointment, which makes it harder to get the help I need. And I'm a comfortably off, articulate woman with minimal pressures in my life.
I'm not a healthcare worker, but it feels like the NHS can't currently do what it was set up to do, because successive governments have chosen not to invest in it. Society has changed, too. I guess programmes like the one in this article are better than nothing, but they barely scratch the surface.
What a great - and powerful - read
First, the quality of articles since I subscribed leaves many "nationals" way behind. Why? Because you are not afraid to make an article comprehensive. The nationals take the latest press release and tinge it with their own political flavour and out it pops. Your articles are thorough, the writing good (the one on youth football in Stockport was outstanding), and your investigative work would please Mr H Evans.
Second, this article depressingly exposes once again the immense problems that exist for the poor and vulnerable and the brave souls who try to help with inadequate resources. Health, education, mental health services, housing. It begs the question where does all the money go that governments spend? What are the differences between Manchester and London in terms of per capita spend on health care? Also bear in mind that in the more affluent parts of the country private healthcare is far more common than it will be (I'm assuming -shouldn't do that) in Manchester.
Levelling up! I wonder how much of a fraud that has been? And I wonder, does any political party have half an answer? I don't think so. Politicians talk the talk about this new law or another...it would be rather nice if government could deliver services. They don't at the moment.
Just heard Joshi on Radio 4 Broadcasting House. Well done Joshi. They loved your phrase “Traffic Pigs”. Great hearing Tina Brown big you up on national radio. I enjoy your work too.
Traffic pigs made me chuckle too Jeanie when I heard it on Sunday. 😂
A young person I know is a GP in a deprived area, she says she spends very little time practicing medicine and a lot of time on the phone seeking help from social services, drug addiction centres, refuges for battered women etc.
She is in her early 30s but the stress of the job has resulted in her reducing her working week to 3 days.
Excellent, illuminating piece. Thank you.