Blame the doctors

Dr Grumble has only just caught up with this weird story about payment for visits to the GP. This is not the patient paying the GP. It is the GP paying the patient. It all hinges on concern about differences in life expectancy between certain social groups. Dr Grumble has covered this topic before. Regular readers may remember that Dr Grumble has regularly been told the tale about how life expectancy plummets as you travel on the tube from Kensington to the East End. That anyway is roughly the story that gets trotted out. There is the strong implication that this is all the consequence of poor access to doctors and that we must roll out polyclinics to address this issue.

In Glasgow there is a 28 year difference in life expectancy between areas that are just 8 miles apart. Can this really be due to differences in medical care? Can this possibly make sense? Is the fact that in the worst areas of Glasgow they smoke and drink to excess, mash up and inject sleeping tablets, sniff glue, get fat, take little exercise and get involved in fights really the fault of the local GP? If you pay these people to go along to the GP is there any chance that they will change their ways or will they take the £20 and buy heroine?

Amongst the people who come to get their £20 there will be some who are overweight. If the doctor advises them to lose weight what is the chance that they will be able to do so long term? If he finds people who smoke will it be news to them that smoking is bad and they should stop? If he finds people with a high blood pressure would the sort of person who can't be bothered to go to the GP unless they are given £20 take the necessary pills reliably? If the doctor finds their housing is cold and damp will he be able to persuade them to pay for heating with the money they don't have? If they are single mothers with more children than they can cope with will he be able to persuade them that the contraception they didn't bother with last time might be a good idea? Or might somebody already have made that point to them?

Who is responsible for the creation of these deprived communities? Does the fault really lie at the doctor's door? Or could it lie at the door of Number 10?