SUPPORTING WELSH GPs AT THE DEEP END
50 years on from GP legend Dr Julian Tudor Hart’s seminal 1971 article on ‘the Inverse Care Law’ about health inequalities, his premise that “the availability of good medical care tends to vary inversely with the need for it in the population served” remains pertinent.
And RCGP Wales are now following RCGP Scotland in initiating the ‘Deep End’ model of general practice.
Calling for a common language Dr Laurence Dorman, RCGPNI Chair
The beauty of general practice is our diversity and flexibility. As GPs, we are at the heart of local communities, and this allows us to design our services based on the needs of our patients. But it’s been a difficult two years as the Covid-19 pandemic forced our colleagues across the UK to operate services differently, virtually overnight. This was necessary to protect patients and our practice staff, but this shift in care was not without its challenges. In Northern Ireland, it became clear to us that one of the reasons patients and the wider public struggled to understand the change in our GP services is that we were not using a common language to describe our remote offering. Terms such as 'triage' are difficult to understand for patients – and the media – and are often conflated with ‘remote consultations’, despite being different things. Inadvertently 'apologising' for not offering a faceto-face appointment in the first instance, or suggesting these service changes were temporary, has been confusing for patients. One consequence was a dilution in understanding of the challenges
In 2009, Professor Graham Watt and colleagues from Glasgow University joined with GPs in many of Scotland’s most economically deprived areas to tackle the underlying reasons for discrepancies in health outcomes, with general practice core to the project. The model has been replicated internationally, but not yet in Wales, until now. A project proposed by RCGP Cymru Wales and spearheaded by immediate past jointChairs Dr Mair Hopkin and Professor Peter Saul has been granted initial funding for 18 months by the Welsh Government. The 'Deep End' describes the additional needs for populations living in the most deprived areas and the impact this has on workload for the GP practices that support these communities. Evidence shows that deprivation means people get sicker younger and are far more likely to have multiple physical and mental health co-morbidities.
Difficulties with health literacy compound these challenges as many patients require additional support to benefit from healthcare advice. In turn, the need for primary healthcare increases in both volume and complexity, meaning that 'deep end’ GPs and their teams are struggling. “We were delighted to receive the go-ahead from Welsh Government for this pilot project,” says Mair Hopkin, “the College has played a key role in the development of ‘Deep End’ in Scotland and I’m pleased the College is leading the way in Wales”. Peter Saul added: “This will provide a framework for tackling entrenched structural inequalities.” Current Chair of RCGP Cymru Wales, Dr Rowena Christmas, said “I want to thank Mair, Peter and everyone else who have worked so hard to make this proposal a reality.”
in general practice from policymakers and stakeholders. While respecting the autonomy of GP practices to deliver services in the best interests of their patient populations, we thought it was essential that on first point of contact with their practice, patients are greeted in a way that will allow them to firstly understand, and then value the service they are going to be receiving. This is why we developed our Common Language paper, which received endorsement from RCGPNI Council and subsequently at national level from UK Council. This paper was not intended to reopen the debate on the merits of face-to-face versus remote care, or to dictate how colleagues operate their service, but to help foster better understanding of the current remote service model which is likely to be with us, in some form, for many years to come – something my colleagues and I have been making clear in the NI media recently. Work is ongoing to develop some practical resources for GP practices and we are continuing to engage with patient representatives. If you are interested in our work to support a common language and better patient understanding in general practice, please get in touch: chairni@rcgp.org.uk
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