Introduction by Croakey: Since 2009, the Deep End project in Scotland has worked collaboratively with general practices in efforts to improve the quality of care for communities with high levels of poverty, exclusion and disadvantage.
The ‘Deep End’ refers to GPs who work in the deeper end of the social gradient of health. The project explicitly seeks to address the Inverse Care Law, whereby those communities most in need of quality healthcare often receive less and lower-quality healthcare than wealthier communities.
For more than a decade, the Deep End movement in Scotland has also been producing reports on issues such as climate and health inequalities, prison health and efforts to increase primary care education in areas of socioeconomic deprivation.
The movement has expanded internationally, with Deep End projects now in Japan, Ireland, England and … Canberra.
Last week, Dr Liz Sturgiss, a GP from the Deep End project in Canberra @DeepEndGP_CBR, tweeted for @WePublicHealth and a summary is provided below.
Liz Sturgiss tweets:
We acknowledge that the Ngunnawal and Ngambri peoples have lived in the Canberra region for over 20,000 years. @DeepEndGP_CBR acknowledge the continuing culture of First Nations people in our region and pay our respect to the Elders past and present.
This week @DeepEndGP_CBR will be sharing what it is like to be a GP in the most disadvantaged communities in Australia.
How did our group get started? You can read all about it in this publication in the Australian Journal of General Practice (@AJofGP).
The article says:
Our Canberra group has found the framework to be valuable for peer support and advocacy.
We hope that other Australian GPs will be encouraged by our experience and develop their own group in their region.
Establishing a national group of Deep End GPs in Australia would take us to the next level of engagement and follow in the steps of the Scottish movement.”
The Deep End movement started in Scotland with @grahamwatt4 at the helm. It is a policy, advocacy and collegial support network that has now spread to countries around the globe. The latest news is online.
What is it like to be a GP working with disadvantaged youth and rural communities?
Hear from GP @Tanyajindy1 in a recent conversation with @ACTHealth for mental health week. Watch/listen here.
Challenge poverty
It’s @AntiPovertyWeek – 1/8 adults and 1/6 kids in Australia live in poverty. Poverty is a global problem.
Below a short clip from Scotland: “We have a system that traps people in the poverty they find themselves in.”
Dignity is a film for #ChallengePoverty Week 2022 by @hannahcurrie, featuring @CrewDarkwood and @CranhillDT.
Watch it below.
Read more about the Inverse Care Law.
“The inverse care law, whereby healthcare favours more assertive interests and in doing so compounds the disadvantage of patients and communities with the poorest health, exists in most health systems.”
We see the inverse care law everyday in general practice.
Patient-centred care is a critical part of effective general practice. Below is a thread about centredness in general practice care, an area that has been under study for decades.
Advocacy matters
See this study published in 2019: ‘Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015’.
Increasing GPs had a bigger effect on population life expectancy than increasing other specialists. Why could this be? “The primary care paradox” explains the effectiveness of generalist care provided by GPs.
Personally I see a huge difference in the services available to patients with money and those without. In reality our healthcare system works like it is a two tier system.
Do we *really* have universal healthcare in Australia? Interested to hear from clinicians working in general practice, especially in disadvantaged areas.
Led by @AfroPHC and other allies, there is an open letter urging leaders around the world to prioritise primary care for healthier communities. The first point of the letter is especially relevant for #HealthEquityMatters.
Read more and sign on – https://phc3for1.org
Healthcare can be difficult to access for priority populations. Sometimes we have to take the care to the community.
Chat to Pat is a mobile bus clinic from Directions Health that has regular stops around town so patients know where they will be.
See the thread on community health centres in Belgium.
In the Deep End there are innovative models delivering general practice to disadvantaged communities. Most of these models must rely on funding sources in addition to Medicare.
An example: The Deep End GP Pioneer Scheme is one program supporting the GP workforce for the most disadvantaged communities. There is info in this publication by @dnblane: ‘A Change Model for GPs Serving Deprived Areas’.
There are many Deep End groups on Twitter – you can follow to see the latest in that local region:
