Inclusion health and missingness in health care: dig where you stand

Professor Williamson rightly highlights the plight of the ‘missing’ within our urban conurbations¹, so well described and championed by colleagues in ‘deep end’ practices.

I wonder however, if we may be missing some ‘missing’. Previously we would have known our older housebound patients. Those who were frail and multimorbid. Those less able to access care for a variety of reasons. Those living at the ‘Far End’². They contacted or we remembered. But now it seems we are less aware of this vulnerable group. For a variety of reasons – the pandemic induced hiatus, the pressure of ‘on the day’ demand and the media driven shifting expectations of health care – we are perhaps missing the ‘missing’ at the ‘Far End’.

So with shovel in hand, I feel inspired once more to ‘dig where I stand’³. But the ground is hard. I need some help. I’m grateful for our local ‘frailty practitioner’ reviewing our older patients (at home) not seen in the last year. Such innovations unearth so much. The need for bio-psycho-social-spiritual care and the consequent supportive infrastructures.

The soil beneath our feet is fertile. There are many at the ‘Far End’ in need of care. But I suspect our shovels may not be enough. Perhaps we need the specified complexity of our practice clusters, health and social care partnerships, and health boards, to sustain this dig. Perhaps we even need the mandate or incentive of government through contract.

References
1. Williamson AE (2023) Inclusion health and missingness in health care: dig where you stand. Br J Gen Pract 2023; 73 (735): 436-437. DOI: 10.3399/bjgp23X734985.
2. Macdonald G, Vernon G, Mcnab D, Murdoch JC (2020) Home visits for vulnerable older people: journeys to the ‘Far End’. Br J Gen Pract 2020; 70 (699): 479-480. DOI: 10.3399/bjgp20X712685.
3. McIntosh A (2001) Soil and Soul: People versus Corporate Power (Aurum Press, London). Google Scholar.