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More Scottish GPs needed to fight heart disease

MSPs warn of ‘fatalistic’ attitude of people living in poorest areas

Louise Prime

Monday, 24 September 2012

People living in the poorest communities of Scotland have low expectations of good health and fail to recognise that their symptoms are of concern, members of the Scottish Parliament have reported. They recommend that the Scottish Government should review whether GP numbers are adequate to meet the needs of patients in deprived communities and ethnic minority communities.

The public audit committee’s inquiry into cardiology services in Scotland also called for the Scottish Government to clarify how it is supporting training of GPs, and other medical professionals, to work effectively with patients with comorbidity who need a wide range of health and social care support.

Public audit committee convener Iain Gray said: “While Scotland does indeed have a higher ratio of GPs per head of population than elsewhere in the UK, the current government formula for allocating resources does not necessarily lead to higher GP levels in deprived communities. And that’s where there is a concentration of comorbidity.

“We are therefore requesting that the Scottish Government reviews whether GP numbers are adequate to meet the needs of people in deprived communities and ethnic minority communities.”

Patients and GPs said it could be difficult within a standard GP consultation to fully explore health issues in a way that would allow lifestyle changes to be successful, and GPs in the most deprived areas reported feeling stress themselves because of the challenges of dealing with patients’ complex needs, and greater demand on their services. The committee found that double appointments, or meeting with a nurse for 40-45 minutes, could be more effective than a standard GP consultation in tackling comorbidity.

Scotland’s excessive rate of heart disease is tightly focused in just eight of its 32 council areas. The committee found that some patients from deprived or ethnic minority communities had a fatalistic attitude towards their health, with a low expectation of good health – “people like us die of heart disease, and that’s how it is”. It has asked the Scottish Government to specify “how it proposes to address the attitude within deprived communities and ethnic minority communities that poor health is to be expected”.

Some patients did not recognise symptoms, or consider them significant – for example, thinking that a heart attack was simply indigestion – until a serious incident forced them to seek emergency treatment. This both worsened outcomes for patients as well as being more costly to the NHS. Men were twice as likely as women to wait to seek help after experiencing sudden acute pain, rather than seeking advice immediately.

The MSPs also called for the Scottish Government, NHS Boards and local authorities to better support the provision of healthy food retail outlets in deprived communities (through licensing and business support), and to identify opportunities for other types of public sector premises to provide healthy and affordable food.

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