At a careers event, I was once asked what my most satisfying case was from my time in GP. Several sprang to mind: a few “clever” diagnoses, people I’d helped through
depression, patients, and families I’d helped through a diagnosis of cancer, their treatment and toward a good death. But one particular case from recent memory sprang to mind. Between the GPs and the local hospice team, we had guided a young Slovakian man who lived in a terraced house with 15 other family members through his oncology and then end-of-life care for metastatic cancer.
Here was a desperately poor man in a desperate situation right on the margins of society who had been given the best medical care possible and permitted to die comfortably with his family around him. This was the civilising force of the NHS demonstrated in all its wonder.
Although working in a poorer area can be tough – higher consultation rates, more mental illness, earlier onset of multimorbidity, more social complexity – you get out what you put in. It constantly amazes me how those with very little often show the most gratitude for our meagre offerings. Whilst GPs working in so-called “deep end” areas struggle with stress and burnout, they are a motivated, kind, positive, caring and passionate group who demonstrate great respect for their patients and real intellectual engagement with their work. They make wonderful and inspiring colleagues.
Deep End GPs care for the people who slip through the cracks in society: the young with multi-morbidity who do not fit neatly into a single organ system of hospital specialism and who are not old enough to meet a geriatrician; the disabled caught in the poverty trap; the alcoholics with severe depression who cannot get help from the mental health team due to their ‘dual diagnosis’; the young frazzled single mums for whom getting through each day is a miraculous piece of survival; the working poor who lead sicker shorter lives merely as a result of being born in the wrong place at the wrong time; the multitude suffering from illness due to loneliness, addiction or the after effects of abuse; and the millions who don’t have access to the healthcare they need thanks to the Inverse Care Law. Making a small difference to these problems or offering small kindnesses can have a massive impact.
Deep End GPs see lots of pathology and lots of people needing real help.
If you are looking for a cause to devote a career to, you would struggle to think of one that is more worthy or interesting.
And right now is a great time to be involved. Teams of GPs are coming together to provide specialist inclusion health services (see the Faculty of Inclusion Health), highlight the problems faced by deep end GPs (see Deep End Glasgow and the recently formed Yorkshire and Humber Deep End group), create educational and service partnerships to provide help and advocacy those most in need (see Partnership for Health Equity) and forcefully lobby for equitable funding of primary care (see the Tower Hamlets Save our Surgeries Campaign).
Unconditional, continuous, personal care provided for all patients whatever the problems they are faced with is the essence of UK primary care. Come and join us at the deep end and help deliver healthcare and humanity to people who would otherwise be drowning. Help send a message: that all lives are equally worthwhile and that the basic humanity that underpins the NHS remains intact.
Tom Ratcliffe is a GP in West Yorkshire and a founder and driving force behind Yorkshire and the Humber Deep End GP.