The social responsibility of GPs working in deprived areas: can this help tackle health inequalities?
In Scotland, life expectancy and health outcomes are strongly tied to socioeconomic status. In particular, socioeconomically deprived areas disproportionately suffer from high levels of premature multimorbidity. To tackle these inequalities in health, challenges in the most deprived areas must be addressed. One avenue that merits attention is the potential role of GPs in helping to address health inequalities, particularly as they have been described as ‘advocates for the people’. Inherent within this social responsibility model is that GPs have the responsibility beyond individual patients to the communities they practice and within the wider health system. However, minimal research has been done to understand how GPs view this role and what they think can be done in primary care to address the problem of health inequalities.
Using semi-structured interviews with 24 GPs working in some of the most socioeconomically deprived practices in Scotland, this thesis research explores the experience of GPs working within primary care and how they might combat this growing health divide via the mitigating of existing health inequalities and, potentially, the prevention of health inequalities. Interviews were conducted in the fall/winter of 2014-15 and analysis was aided by NVivo software.
Beyond their frontline work and duties traditionally ascribed to general practice, the interviews revealed that many of the GPs felt they could make a difference through advocacy efforts ranging from individual, community, and policy/political levels. In line with this, many of them also noted the need to provide a voice for the deprived communities in which they work.
A group known as ‘the Deep End’, comprising GPs working in the 100 most socioeconomically deprived practices of Scotland, has been particularly beneficial in providing a clear platform for the organisation of this advocacy. This primarily has been in the form of political advocacy, policy work and new initiatives involving general practice in deprived communities.
This research finds that GPs working in deprived areas feel a social responsibility to not only address individual patient clinical and social care, but also to influence policy and politics which relate to the social determinants of health. While many of the GPs acknowledged the social responsibility of their profession, strained resources in the context of severe levels of multiple deprivation and multimorbidity makes this difficult. The Deep End group has been instrumental in raising awareness of the problem of premature multimorbidity in deprived areas, but now the challenge is ensuring that primary care resources match need.