The link between poverty and ill health is long established, as is the high cost to the NHS - and indeed wider society - of dealing with the consequences. And with some of the unhealthiest citizens in western Europe, Scotland has particularly good reason to look for new solutions to this most complex of problems.
With this in mind, the results of a study recently run in GP practices in some of Glasgow’s most deprived areas deserves careful attention.
The Care Plus initiative, led by academics from the universities of Glasgow and Dundee, focused on providing patients suffering “multimorbidity” – i.e. two or more long-term physical or mental conditions – with the very thing so many GPs complain they are not able to give their patients: time.
As most of us know from our own experiences, GPs are under severe time pressures. Consultations last, on average, no longer than 10 minutes. Who hasn’t seen their doctor surreptitiously checking the clock on numerous occasions during a consultation? The sheer number of patients to be seen requires it.
But what if GPs were able to give longer – say 30 minutes – to patients with multiple issues, allowing them to get to the bottom of health problems, instead of just skimming the surface? How would this change the way doctors thought about the illnesses they were presented with and the treatments offered? Would it improve outcomes for their patients? And could it save money?
These are the questions the researchers and GPs who took part in the scheme aimed to answer. And the findings were both interesting and encouraging.
To be clear, the patients involved didn’t necessarily get better. But, crucially, unlike their peers who did not receive the extra time and support, they didn’t get worse.
Unsurprisingly, giving patients more time with their GP costs money – in fact, the price per patient rose to an average of £979. But this is considerably cheaper than an overnight stay in hospital. And the intensive one-to-one approach also turned out to be more cost-effective in terms of reducing the need to prescribe certain drugs.
In some ways, no one should be too surprised by all this. After all, the benefits of talking therapies have long been known. Many of those in poverty live stressful, chaotic lives; the opportunity to fully examine how this links to ill health and do something about it surely makes a difference to the outcome.
But no single approach is a silver bullet, especially at a time when health boards are struggling to meet levels of service, GP vacancies lie empty for months and doctors are retiring from the profession in their droves. And, as the Care Plus study highlights, practices in poorer areas are already routinely under-funded in comparison to their wealthier counterparts.
This study offers some hope, however, and primary care providers should be encouraged to think creatively about how they could reconfigure their services to give more time to those who would benefit most. Many stressed-out GPs would also likely get personal and professional satisfaction from being able to better help and support their patients. Time, it seems, really could be a healer.
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