GPs working in the 100 most deprived communities in Scotland have warned that patients in poor areas often get a worse service from the NHS, and cuts are increasing the unfairness.
The Royal College of General Practitioners is publishing a report from the group representing doctors working in areas of concentrated poverty, which calls for GPs in these communities to be freed up to spend more time with patients.
General Practitioners at the Deep End warns many communities in Scotland are affected by the so-called Inverse Care Law, which says health services are often less effective in the areas where they are most needed.
Typically, at the end of their lives men in poor areas suffer ill health for 10 years, and women for 14 years, compared with figures of five and six years respectively in better off neighbourhoods.
Residents of deprived areas are also much more likely to suffer from multiple chronic conditions than those in wealthier postcodes.
However, distribution of GPs is flat, which means that clinics dealing with poorer populations are more stretched, and have the same time and resources to deal with the complex medical needs of their patients.
The study argues that centralisation of services, which can occur as health boards attempt to make efficiencies, also disadvantages patients in deprived communities.
GP practices increasingly encourage self-help, and offer health advice over the internet or with leaflets, but illiteracy can be a barrier to access in some of their practices, the Deep End group says.
The trend towards asking nurses to carry some of the workload of general practice can be obstructed in GP practices where multiple illnesses are common – as more complex cases have to be referred to the GP anyway.
Meanwhile, centralising services such as sexual health and family planning or specialist weight management clinics can increase the bias towards better-off areas as patients in deprived areas may be less likely to make use of them.
Professor Graham Watt, Professor of General Practice at Glasgow University and lead author, said that although the NHS was brilliant at providing universal emergency care, it was weak at preventing emergencies in the first place. He said: "Since 1948, the NHS has supplied GPs in the same way that bread, butter and eggs were rationed in World War II – everybody gets the same," he said. "In severely deprived areas this results in a mismatch of need and resource, with insufficient time to get to the bottom of patients' problems, hence the 'swimming pool' analogy in which GPs at the Deep End are treading water."
Dr Petra Sambale, a GP at Keppoch Medical Practice in Possilpark, Glasgow, said GPs in deprived areas needed to be freed up to spend more time with patients, and more services need to be made available within the communities.
He said: "Our patients tend not to have just one disease, but might have suffered a stroke, and have chronic obstructive airways disease, with a history of heart attack and a lot of social problems. These might be more prominent, so that by the time you have discussed depression, bereavement or housing problems, you can neglect their medical needs, which are very complex.
"Centralisation of services such as weight management doesn't make sense for the population which is the most ill, but won't necessarily access the services. It can look as if there are lots of people who do access the services, but they are those who can make change more easily and have transport. My patients are getting squeezed out by it."
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