Our subsequent medical scepticism project revealed high levels of apathy, distrust and cynicism towards healthcare services and one of the insights from that project was that poor funding into the NHS was impacting the quality of the service. The lack of time afforded to patients and struggles to even get an appointment was regurgitated by multiple participants. Participants indicated they felt they were being ‘rushed’ in and out of GP surgeries and practices and the initial contact was increasingly cumbersome and communication from receptionists unacceptable.
Next, alongside Dr Caitjin Gainty from Kings College London and Dr Agnes Forster-Arnold from the London School of Hygiene and Tropical Medicine, we explored health activism and medical pluralism in South London. In this project, counterpublic health spheres of Brixton were looked at and how people from marginalised communities were taking their health into their own hands, away from mainstream health services, shifting the power of who controls their health outcomes and more along the lines of self-efficacy. This project raised important issues related to doctor / patient relationships, the need for greater health integration, the significance of wellbeing activities promoted by inner-city GP surgeries and individuals becoming distrustful of healthcare services and hence, going elsewhere for their health needs which they deem as more relevant, available and effective.
The solution to these problems are not in isolation, and based on previous research, it is a recurring theme which indicates the different elements who have worked on various health-related research have already flagged this concern. However, if there is a recurring theme across different projects – this indicates that there is a problem which needs to be solved and this is not solved by people working in silos. Such silo-working is common to institutions, which means there is less collaboration and more failure. Hence, different partners need to come together to address this facet.
Unsurprisingly then, this aspect has been revealed yet again but this time from yet another different angle. While conducting our Cost of Living project into current financial precarity, it has arisen again. As we found 18 months ago with the medical scepticism project, earlier this year in our KCL health activism project and here we are again with a different subject facing with the same issue.
There also appears to be a three-staged journey to health occurring across South London and the urban locale.
A person has gone from stage one, being angry, then opted for option two, yet found this was too expensive, so then finally sufficed with option three. For instance, from our medical scepticism project at stage 1 we heard:
“Okay. A&E is a myth, cos I've been in it ... I've been waiting seven, six hours to be seen for something for which they've just given me Co-codamol for, so yeah. Sometimes it's best to just do your own research. The Internet's a great tool and you have to use that to your advantage.”
(from our medical scepticism project)
“The main thing is the timeframe. And I'm assuming a lot of people go through this with the NHS. Will it be a surgery or procedure that's up and coming. It just takes too long. You know, my surgery, my knee injury, I broke it in the end of 2009 in school time when I was in school in Year Nine. And I had the surgery done two years later in 2011 as I was about to finish school. So that's a two year wait, you know? So sometimes you think that you don't get taken serious. That's the aspect where the trust sometimes goes away.”
(from our medical scepticism project)
Then at stage 2:
“Yeah. I would, if I need to go private, you know, for a quicker resolution, which I've done before, I have no problem with that. As we all know the NHS just takes a bit of a long time.”
(from our medical scepticism project)
“The last time I had a toothache I couldn't get any NHS dental appointments. I had to go private and I have to pay so much for it [sic]. Yeah. To pay nearly £250. It was like, oh my gosh! I didn't have the money but, because I was in so much pain, I had to borrow to then see a dentist.”
(from our Cost of Living and MLTCs projects)
“Because of the inadequacies, with the public health sector, like with myself and my wife, you have to go private, which is costing a leg and an arm [sic] because the NHS wouldn't be willing to give you regular appointments.”
(from our Cost of Living and MLTCs projects)
“You need to do your research for that, but if we have good private health care that would save us a lot of time … because really when you have an incompetent GP you’re wasting your time, [as] then you end up after being in the hospital two, three, four times … it doesn't solve the problem.”
(from our medical scepticism project)
Finally, culminating in stage 3:
“The way the police used to handle Black youth in the late 70s fuelled distrust of authority and the government. As a result, anything which came from them was seen as not to our benefit. Those youth from that time also had knowledge of natural treatments from their parents and grandparents. They didn’t have knowledge of pharmaceutical medicine but they did of natural medicine, the proof is that when people come to my shop they have knowledge of this: ‘Dandelion is good for this,’, 'Neem is good for this', 'Sarsparilla is good for that', they know. They may not be nutritionists but they know, in general, stuff which is good for them."
(from our Health Activism in Brixton project)
“Natural products, or natural remedies are better. This is a consensus through any community. So, you’ll always find within Brixton, the Black community, the herbalist, the Rasta man who’s got the tea or different herbs for different things. This is a culture thing, it’s a good practice. Whether all the herbs they’re selling are a treatment for a specific thing you got to do your research on and which herb treats which ailment. Definitely there is, I would say, a cultural practice of taking certain herbs for certain ailments. The fact is, you do your research, you need a certain herb for a certain ailment, you can go down Brixton High Street or the market and you can take it. It’s just standard practice natural herbs and teas are better for you than popping pills. I think that’s a general consensus in the community.”
(from our Health Activism in Brixton project)
“Sometimes they just give you a quick prescription for some antibiotics, when really and truly natural remedy could serve you better, sometimes, I mean, they're trying to save the costs, so they give you a cheap alternative in terms of prescriptions … I do trust them but like I said, to a certain extent which is, you know, I’ve been given bad advice in the past which has backfired on me.”
(from our Medical Scepticism project)
Centric are insight-led, rather than GPs who are evidence-led – yet they will miss these nuances. These nuances are also not captured in the data kept at surgeries. A forum of various professionals may need to align collaboratively, as the same themes are appearing across multiple fields of enquiry, cross-thematic collaboration and a multi-disciplinary approach. More recently, this has also been noted, as the twin-impact of COVID-19 and a stretched NHS have brought to light glaring gaps in provision which impact healthcare disparities, inequalities and criticisms about the role and function of the GP surgery within a community.
The notion of ‘rethinking the GP practice’ has been discussed by some commentators over the last 20 years (Sturmberg et al., 2003; (1) Dowrick, 2007; (2) Mulley et al., 2012; (3) Harper, 2013; (4) May, 2014; (5) Wilkinson, 2014; (6) Wancata, 2016; (7) Marshall, 2018). (8)
Health Education England, who recently outlined a vision of future healthcare which is built on the whole person, also referred to as ‘generalist care’. Person-centred care emphasises the importance of soft-skills such as communication, empathy and relationship-based care. The therapeutic value of relationships has been noted in research and also clinical experience. All of which seems to be absent in the post-COVID 19 medical landscape.
Yet personal care is not necessarily the same as personalised healthcare, as clinicians and healthcare professionals provide ‘evidence-based’ justifications for clinical decisions yet, are unable or unwilling to offer tailored approaches (Reeve, 2022). (9)Reeve (2022) discusses how in her capacity as a GP, she works alongside patients to explore illness based on information from patients directly along with professional experience to then develop a tailored explanation, taking into consideration the whole person. Based on this, a management plan is developed, which is then followed up and if necessary, evaluated further for any scope for review or revision.
In the focus groups for the Medical Scepticism project, we heard the following from people in terms of rethinking the GP Practice:
“When you walk into the GP, you actually see the sign up 'don’t insult us' … 'don’t abuse us' … excuse me … they should [also] apologise to us … and tell us that they are sorry and that they are here to support us and then we can trust them again.”
“If there was an office inside the GP’s where I could discuss an option [for treatment] where they could say 'we have Dr so and so here if you would like to go for that option' that sort of presence inside the actual GP.”
“A multi-disciplinary kind of service is what the NHS needs to do, in order to make it more personal. The reason being is a person is made up of different elements, it’s not just your physical health but also your mental health … and that’s a holistic approach.”
Rebuilding healthcare round whole-person-centred practice offers crucial opportunities to:
(Reeve, 2022). Randall et al. (2017) found in their systemic review of community-based nurse-led clinics that such clinics have positive effects on the patient experience and on patient-reported outcomes, as well as an improvement on access. These are clinics "focused on maintaining people in their communities, and keeping them out of hospital where possible”.(10)
The GP Surgery as a community space for generalist and holistic practice, with community input and feedback to generate community buy-in to the local GP, requires exploration. The importance of this is to reconnect people to their local health centre and GP surgery, foster trust and engage people with their GP. This can also potentially ease the strain from GPs by focusing on community wellbeing via gardening, socialising, befriending, holistic treatments and as a hub for community involvement.
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References
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