GPs in at the Deep End

Shown below are extracts from a report published in March 2012 by GPs working in 100 general practices serving the most socio-economically deprived populations in Scotland. To some, this may seem a world apart from their own experiences living within the Poole and Bournemouth area. Others will already be encountering some of these problems.

One thing is for sure, as the austerity measures begin to take grip, more and more people within our communities will suffer. Even more worrying is the fact that only 20% of the total spending cuts have been implemented and many of those are yet to bite; so people are yet to encounter the full impact of what is heading down the track.

The issues raised are just more examples why we must all join in solidarity and fight the cuts. The full report can be downloaded here – GPs at the Deep End




Concerns have been raised in several quarters about the consequences of the Government’s welfare reforms and other austerity measures, which have been implemented since October 2010. These concerns include the negative impact that cuts in benefits are having on some of society’s most vulnerable individuals and families.

GPs and primary healthcare professionals are at the frontline in responding to the needs of these people. “GPs at the Deep End” work in 100 general practices serving the most socio-economically deprived populations in Scotland. This report draws on the recent experiences of Deep End practices, as they were asked to reflect on the effects of austerity measures on patients and on patient care. Responses included general comments and individual case studies.

The report makes for grim reading. It describes the direct and indirect consequences of austerity policies on patient health and on the systems that are in place to support health and wellbeing. The case studies are a graphic illustration of the strain these systems are already under; and more importantly, the strain that the most vulnerable – the elderly living in fuel poverty or the homeless mother and her child – are experiencing right now.

Patient health
A central concern of Deep End practices is the number of patients with deteriorating mental health.

At one end of the spectrum, there are those who are in work, and previously well:

  • under increasing stress at own jobs due to cutbacks
  • taking on extra work/jobs, with resultant impact on family and relationships
  • experiencing stress of job insecurity

At the other end of the spectrum, there are those with chronic mental health issues and established physical problems who are “deemed fit for work” and have their benefits cut:

  • struggling to make ends meet
  • increasing contact with GPs and psychiatry
  • increasing antidepressant/antipsychotic use
  • self-medicating with drugs and alcohol

Practice impacts

  • Changing workload. Most patients appeal the WCA decisions and ask for letters in support of appeals. This is encouraged by benefit support workers and solicitors. As noted, however, it impacts on practice time that would otherwise have been spent on health concerns.
  • Access affected. Pressure on appointments and appointment length as a result of the above, including increasing volume of unscheduled appointments in some cases.
  • Staff morale. Several practices report sadness and frustration among staff members at their inability to alleviate the suffering they see, and increased stress due to extra workload. Again, this has potentially significant detrimental impacts on patient care.

Secondary care and support services

  • Patient transport for outpatient appointments has been affected by cutbacks, such that there have been reports of many patients complaining about long waits, with some elderly, frail patients arriving home after midnight. Will this result in higher DNA (did not attend) rates?
  • Delay of discharge letters from secondary care, which can result in potentially serious prescription errors, is often due to typists being off, or unfilled posts.
  • Increasing funding and access barriers to residential detox.
  • Addiction workers struggling to do any structured addiction work because they are too busy trying to help patients in crisis.
  • Patients are attending Community Addiction Teams for money due to benefits being cut; but addiction and social services have run out of funds for crisis loans.
  • Other examples that Deep End practices gave included rehab services, occupational therapy, and heart failure nurses being harder to access.
  • One respondent felt like GP practices were a “dumping ground”, as other services are affected by cutbacks.

Social work and housing

  • Several descriptions of a service that is overworked and understaffed and that is, ultimately, failing some of the most vulnerable members of society.
  • Reports of vulnerable adults and children being unallocated despite serious concerns for their safety and/or wellbeing.
  • Difficulty getting social work colleagues to attend practice meetings.
  • Increased difficulty getting patients into respite care.
  • Increasing reliance on voluntary sector.
  • Addiction services and social services have been categorically told to turn to charities for basic items such as beds and cookers when children are being returned from care to their parents.