A window into the intense and sometimes shocking challenges facing our health and social care system has been opened by a study focused on GPs working in what the authors describe as the ‘deep end’ of Northern Ireland’s most deprived communities.
They paint a bleak picture of the deadly impact of health inequalities. Compared to those in relatively affluent districts, people in areas of socioeconomic deprivation live shorter lives in worse health.
The GP practices serving them have to contend with larger patient lists, increased demand and higher rates of physical and mental health comorbidity. The funding and workforce shortages felt throughout the health and social care system are amplified. “I could put on 10 doctors on every day and I wouldn’t cope with the demand,” says one of the GPs.
The spectre of the Troubles looms large in the GPs’ testimony. It’s a vivid but dreadful reminder that while the peace process may have largely removed the bomb and bullet from our communities, our violent past continues to cast a shadow over the generation born after the Good Friday Agreement.
One of the GPs interviewed by the British Journal of General Practice researchers said these young people are experiencing the consequences of “an unstable childhood environment”.
“I think that brings a different mental illness that we’re definitely seeing a lot more now through the use of street drugs and alcohol,” they said.
“There’s such huge issues with mental health problems, and multi-factorial reasons for that, but I think a lot and can be related back to the Troubles.”
In a grim example of what this means in reality, one GP spoke of two different patients who received paramilitary-style attacks by appointment and who asked the doctor beforehand “for diazepam in anticipation of these organised beatings”.
A depressing theme of the study is just how normalised poor health has become in some communities. People “expect chronic disease in their lives”, observed one GP. Another added: “They seem to feel that they shouldn’t be able to walk the length of themselves at 60.”
Two patients received paramilitary-style attacks by appointment, asking the GP beforehand for diazepam in anticipation of these organised beatings
The devastating impact of spiralling waiting lists for hospital treatment is also a shared concern of the GPs, who feel a sense of helplessness. One recalled a patient marooned on an ‘urgent’ list for six years, but “there’s nothing that we can do…”
They report how dependency on prescription drugs, obtained illicitly, is a hidden problem in rural areas.
Stormont’s draft Programme for Government talks about addressing health inequalities, a task which is demonstrably beyond urgent. Supporting GPs and other health and social care professionals, especially those whose vocation calls them to ‘the deep end’, to do their jobs properly must be the executive’s priority.
