A Machine that does the Work of Two Men

Thursday, 06 February 2014

From 1900 to 2000

Medico-Chirurgical Hall

Prof. Graham Watt

Lessons from the Deep End


Minutes of meeting held on 6th February 2014 in the Society Hall, Foresterhill.

The President, Dr Colin Hunter presided.

The President introduced the evening's speaker, Professor Graham Watt, Professor of General Practice at the University of Glasgow. The title of his talk was A machine that does the work of two men - lessons from the deep end.

Professor Watt started by showing a photograph of the Aberdeen Royal Infirmary site when it was opened in 1936, when his uncle had been Lord Provost.

He then turned to the title of the talk. 'A machine that does the work of two men, but it takes three men to work it' was a quotation from a comedian, Mr Spike Milligan and Prof Watt said that was a good definition of the National Health Service.

He talked about deprivation and its association with health problems. Most practices with high deprivation were in the West of Scotland, although there was one in the Torry area of Aberdeen, but there were not any more GPs in those practices. He had become involved because the Royal College of General Practitioners had wanted a report on what GPs could do to address health inequalities. He had been keen that it should not be 'another report' nor 'another tool kit' so he had started by listening to GPs and a group of 100 GPs from areas of deprivation had been formed and were called the 'deep end GPs' after the shape of a graph showing the relationship between deprivation and health problems. The group had led to publications and reports to government.

GPs can be advocates for deprived patients since they are independent and Prof Watt gave examples of instances when GPs had been influential in influencing public opinion.

He then talked about the start of the National Health service and quoted Aneurin Bevan: 'Illness is a misfortune, the cost of which should be shared by the community'. The NHS was set up with universal coverage and with GPs having a gatekeeper function and a list system. The fact that everybody is registered with a GP gives scope for research and he spoke at length about the pioneering epidemiological studies done by Dr Julian Tudor Hart. He talked about the lack of additional recourses in deprived areas and about some of the problems this causes including increased stress in staff. Those who would benefit most from intervention often do not receive it.

Looking forward, Prof Watt said that the usual public health policies e.g. for communicable diseases do not work for deprivation. Multiple pathologies are increased in areas of deprivation (defined as 2 or more conditions) and they occur 10-15 years earlier than in non deprived populations. 25% of people take regular analgesics, 15-20% are on antidepressants and the majority of people with multiple pathologies are under 65 years of age. The modem lack of general physicians causes fragmentation of care. He suggested that management could be decentralised and suggested that GPs are best placed to help reduce health inequalities.

To facilitate that, GPs need more time and he talked about a randomised controlled trial which showed that allocating more consultation time to patients with multiple pathologies did improve the quality of their lives by reducing the severity of some symptoms and slowing their progress. If an empathetic relationship can be established between the GP and patient, then self help is more likely to happen with patients often being able to tell us their treatment goals.

Finally, he said that that the NHS needs to work as a social institution with good local integrated systems thus resulting in a machine which does the work of two men but only needs one man to work it.

There followed a question and answer session after which the President closed the meeting.

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