How 'Deep End' GPs do more than treat illness among Scotland's most deprived communities – Karyn McCluskey

A good GP can be the beating heart of a community and their surgeries become known as places where patients feel listened to, get advice and receive the best care.

Specialist GPs in deprived areas are working to counteract the negative effects of poverty on health (Picture: Christopher Furlong/Getty Images)

In areas around Scotland, the lack of well-being manifests itself in a range of physical and mental health problems, rooted in poverty and hopelessness.

In these areas are Deep End project practices which cover around 100 of the most deprived patient populations, supporting people who experience health inequalities over their lifetimes, with lower life expectancy, problems with drugs and alcohol, depression and often high levels of social isolation. These GPs are focussed not on ill health, but on tackling the wider determinants of health and striving for well-being.

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It’s a challenging and difficult role, requiring resilience, professionalism and deep commitment to long-term change, and many of these GPs have expanded the role of their surgeries to meet the more holistic services patients require.

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The answer to many of their chronic issues lies outside of a prescription pad, in enabling other services and local people to provide the type of support that enables people to recover and develop circles of support within their own community. This is the road to well-being and long-term change.

The inclusion of ‘community links practitioners’ with Deep End and other GP practices has been life-changing for many, helping people address drug and alcohol issues in the community, doing assertive outreach to ensure that people don’t disappear from sight into a negative spiral. I know that a great GP can help transform the lives of the most vulnerable people I see in the justice system, maintain a stable life and avoid being pulled in negative directions.

Dr Carey Lunan is one such GP, working in Craigmillar alongside her phenomenal colleagues in the practice. Recognised last week with an MBE, she accepted it with great humility, accepting it on behalf of her GP colleagues.

She was at pains to mention how difficult the pandemic had been for the most vulnerable in our communities, and the changes they have made to make to ensure that the people she served received the care they so desperately needed.

It so easy for things to get worse, when the support you rely on disappears or goes online; we know already the increase in people relapsing into alcohol and drug abuse and rapid deterioration of their mental health.

Some GPs will have adapted to this pandemic better than others, the move to telephone consultations for the most part demands a different set of skills. It is here that Dr Lunan shines, her MBE should be for her ability to actively listen, not only to what is being said, but what isn’t, to listen to what is between the words.

To ask about the broader things happening in the family, the block, the community which can impact on someone’s health and a call to the GP. You can only do this when you know the people you treat, are invested in the community and recognise that by forming a trusting bond between patient and doctor, giving people dignity and respect and involving them in the journey of improving their health and well-being. So here’s to you Dr Lunan, I hope we see more like you.

Karyn McCluskey is chief executive of Community Justice Scotland

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