Consultations

Deep End Report 6 summarises a discussion about what can be achieved in GP consultations in very deprived areas.

REPORT 6 Patient encounters in very deprived areas: what can be achieved? (May 2010)
Summary | Full report

Deep End Report 29 describes how 15 GPs at Govan Health Centre used additional GP time to address unmet need via extended consultations with selected patients.

REPORT 29 GP use of additional time as part of the SHIP project (June 2016)
http://www.gla.ac.uk/media/media_463781_en.pdf

Relevant published articles

Based on patient reports following 3000 GP consultations

Mercer, S.W., and Watt, G.C.M. (2007) The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Annals of Family Medicine, 5, pp. 503-510. (doi:10.1370/afm.778)

This report is also based on observation of consultations but shows the poorer self-reported patient outcomes after one month

Mercer, S. W., Higgins, M., Bikker, A. M., Fitzpatrick, B., McConnachie, A., Lloyd, S. M., Little, P., and Watt, G. C. M. (2016) General practitioners empathy and health outcomes: a prospective observational study of consultations in areas of high and low deprivation. Annals of Family Medicine, 14(2), pp. 117-124. (doi:10.1370/afm.1910) (PMID:26951586)

Patients may report practitioner empathy without enablement, but never enablement without empathy.

Mercer, S.W., Jani, B.D., Maxwell, M., Wong, S.Y.S., and Watt, G.C.M. (2012) Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland. BMC Family Practice, 13, p. 6. (doi:10.1186/1471-2296-13-6)

A before and after comparison of the effect of additional consultation time on patient outcomes and GP stress.

Mercer, S.W., Fitzpatrick, B., Gourlay, G., Vojt, G., Mcconnachie, A., and Watt, G.C.M. (2007) More time for complex consultations in a high deprivation practice is associated with increased patient enablement. British Journal of General Practice, 57(545), pp. 960-966. 

Development work leading up to the CARE Plus Study

Mercer, S. W., O'Brien, R., Fitzpatrick, B., Higgins, M., Guthrie, B., Watt, G., and Wyke, S. (2016) The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation. Chronic Illness, 12(3), pp. 165-181. (doi:10.1177/1742395316644304)

The CARE Plus results show that additional consultation time is a cost-effective use of NHS resources, partly because quality of life improved in the intervention group but mainly because it declined in the control group i.e. longer consultations slow decline

Mercer SW, Fitzpatrick B, Guthrie B, Fenwick E, Grieve E, Lawson K, Boyer N, McConnachie A, Lloyd SM, O’Brien R, Watt GCM, Wyke A. The Care Plus study- a whole system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility analysis. BMC Medicine, 14, 88. (doi:10.1186/s12916-016-0634-2)

See also the summaries of the following sessions held as part of the Day Release Programme for the GP Pioneer Scheme:

Complex consultations and trauma (15 Mar 2017)

Multiple exclusion/complex consultations (29 Mar 2017)