Are we propagating the inverse care law as GPs?

Aaron Poppleton

doi:10.3399/bjgp19X700913

Watt¹ is right to acknowledge the disconnect between the political rhetoric of addressing health inequalities and the reality of limited healthcare provision in areas of greatest need. He has however failed to acknowledge the role that we as GPs have in propagating the inverse care law. Recognising our influence as GPs in workforce planning, policy, and medical education is important in addressing the gaps in provision. Bespoke resilience training,² leadership, and pastoral support would improve job satisfaction in disadvantaged settings, rather than limited-efficacy ‘golden handshakes’.³ Offering academic GP training in disadvantaged communities presents another means of supporting GP recruitment and raising the profile of academic general practice. Directing research towards Cinderella specialties, that is, mental and public health, presents an opportunity for an upward cycle of community health understanding, engagement, and improved health outcomes.

As recognised in the editorial by Blythe,⁴ integration of a proactive GP curriculum in undergraduate medicine is essential, encouraging recruitment and incorporating social accountability in health care. This should go beyond taught theory, with hands-on participation in health promotion and research projects in disadvantaged communities.⁵ Achievement will necessitate more research-active practices outside university cities, and greater collaboration with third-sector organisations. Experiencing a ‘Tudor Hart’ positive impact will challenge students to consider working in such areas. In contrast, the status quo of increased practice workload in disadvantaged communities risks negatively impacting on GP trainers’ ability to engage and inspire medical students.

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