Feature

Nurturing will be needed for 1,000 flowers to bloom

The government’s white paper Choice and opportunity promises new flexibility and local innovation. Katy Gardner wonders whether general practices have any energy left to innovate with

In the last issue of healthmatters, Brian Gibbons’ article on primary care crystallised our experience over the last five or six years at Princes Park Health Centre in Liverpool, which I have just been setting out for a conference on ‘Can inner city general practice survive?’. After I’d finished preparing my talk I looked at what I’d written and thought: this is incredible. In all this time — which has included: not being able to get a new partner for over 2 years, not having a GP registrar, being uninsurable because the community trust and region could not agree on whose job it was to make the health centre secure, having my car stolen, vandalised and finally burnt — we managed to go on seeing and treating patients and providing health promotion, trying to improve our service, being involved in commissioning and teaching medical students. I came to the conclusion that our inner city practice is wonderful!

I also realised that since I’d joined (18 years ago) the practice has changed out of all recognition. It had just moved into the first health centre in Liverpool, the brainchild of my former partner Cyril Taylor. But over the last 15 years not only the service provision has changed but the nature of our patients has changed also.

We have always had a large number of people with mental health problems on our list and many hostel dwellers, but more recently the number of drug users has escalated and a large influx of Somali refugees onto our practice list has changed the nature of the problems we have to deal with.

While we battle away with the appointment system (there are never enough appointments) we have had very little recognition for the fact that many drug users have to be seen weekly, that some of these have multiple problems, that many have young families that often need large input from health visitors. We have had minimal help with the Somali refugees, who have interpreting needs, physical problems, health beliefs that make it hard to help them, and post-traumatic stress on a scale unknown in Britain.

Because of our reputation and our geographical position we have acquired large numbers of patients who deliberately harm themselves. Most of these patients have been abused and as they build up trust with us many of their horrific stories come out and have to be handled.

Another problem is the increasing hopelessness and disenfranchisement of local people. If there is little to work towards why not just go round burning cars and lopping branches off trees, breaking windows and digging up flower beds. The alternative might be to sit at home and watch TV, looking at adverts for all the things you are never going to have.

Remarkably, we are still here. We are still standing. We have found a registrar to work with us who was born in Russia but has Greek citizenship. We have an associate GP who has given us space to arrange sabbaticals, set up an out of hours co-op and take on a new partner (an erstwhile medical officer in the Gulf War — handy for gunshot wounds and post-traumatic stress management).

We say to the health authority: ‘Thanks, but we want more’. We say to the government: “White paper, flexible contracts, salaried service and pioneering experiments — very nice thanks, but don’t expect us to do it all.’ We’ll need time, help and resources to even begin, if we — and our patients — are going to survive to see the results