The Oxford Dictionary Online defines austerity as ‘sternness or severity of manner or attitude’ and ‘difficult economic conditions created by government measures to reduce public expenditure’. What does this mean for general practice, and what are we doing about it?
For Deep End practitioners, working in the 100 most deprived general practices in Scotland, austerity means increasing pressures on time, diversion from clinical issues, and difficulty in accessing services. For Deep End patients, austerity can mean increasing stress, despair, and a forced choice between heating and eating.
The Deep End report on the impact of austerity asked Deep End practices to reflect on the effects of austerity measures on patients and on patient care, during 1 week in February 2012.1 Most of the issues raised relate to the direct and indirect effects of austerity policies — benefit cuts, service cutbacks, and an increasing number of patients being taken off Employment Support Allowance (ESA) or Disability Living Allowance (DLA).
Responses included general comments and individual case studies. The general comments were grouped into four sections reflecting the consequences for: patient health; general practice; secondary care and support services; and social work and housing. As accounts of human suffering, the anonymised case studies speak for themselves. The examples are recognisable in most general practices,2 but in the Deep End they are commonplace.
The report is not ‘research’. It simply describes the reported experience of GPs working on the front line. From conception to dissemination, including the collection of replies, drafting the report, and sending it to all Deep End practices, production of the report took only 10 weeks.
In the following 3 weeks, the report travelled far and fast. It was sent to every Scottish MP and MSP, and forwarded to Iain Duncan Smith MP, Secretary of State for Work and Pensions. The report was discussed by the Scottish Parliament Welfare Reform Committee. Deep End GPs were invited to meet with Margaret Curran MP, Shadow Secretary of State for Scotland. The Mental Health Foundation highlighted the mental health issues in the report in a letter sent to Chris Grayling MP, Minister of State for Work and Pensions. There has been media interest.3
We were surprised by the speed at which the report travelled. Although modest in size and scope, the findings clearly struck a chord. A formal research project would have taken longer and would have been more expensive, without necessarily achieving the same content. Practitioner experience provides evidence from parts of the service that research tends not to reach. What collated practitioner experience may lack in research rigour, it gains in immediacy, topicality, and relevance.
The report gives expression to frontline GPs acting as witnesses of society. GPs are in a unique position to do this. Unlike politicians, GPs consistently poll high levels of trust in the general population.4 Unlike almost all other jobs in the public sector, GPs have an independence that allows them to speak out. Other groups, such as head teachers, do this at risk of their jobs.
Should GPs be advocates as well as witnesses? Sigerist stated:
‘They well know the factors that paralyse all their efforts. They are not only scientists but also responsible citizens, and if they did not raise their voices, who else should?’5
The coalition government plans to redistribute NHS resources according to age rather than deprivation — a formula that will widen social differences in longevity.6 It is hard to view this move with anything but cynicism.7 Those who will be hardest hit are the least likely to vote. Social exclusion and political disengagement go hand in hand.8
The Deep End austerity report puts a human face on the ‘difficult economic conditions’ experienced by the most deprived members of society. It says less about the fact that these conditions are ‘created by government measures to reduce public expenditure’. There is an alternative, however, to the ‘sternness or severity of manner’ displayed by our current leaders.
Using data from the International Monetary Fund, Professor Danny Dorling has shown that the government's proposed cuts are more severe than in all other major European economies; by 2015, the UK will even rank below the US in terms of public spending as a proportion of GDP.9 As we are so often told, there is a choice, but before public opinion can be mobilised, it needs to be informed.
As Julian Tudor Hart argues in his commentary of the RCGP Occasional Paper General Practitioners at the Deep End:
‘For the immediate future, this necessary step has no political leaders … So everything depends on leadership at practice level … We command far more public affection and respect than politicians. We have listed populations with names, addresses, and votes. We already have power. We must learn how to use it.’10
- © British Journal of General Practice 2012