The importance of rural GPs

ANYONE who has sat by the bedside of a loved one and seen them slowly slip away, will appreciate the importance of good end-of-life care.

Losing a close relative is an emotional, sometimes devastating, experience but it can be made more bearable if you know that they died in as little pain as possible, in the comfort of their own home.

But trying to ensure patients have a “good death” is becoming increasingly difficult for healthcare professionals with budgets being cut and resources stretched ever further, bringing the whole issue of end-of-life care provision in the UK into sharp focus.

However, at Baslow Health Centre near Chatsworth, in the Peak District, it’s something they are passionate about. Dr Louise Jordan is senior partner at the GP surgery, which she runs with Dr Abi Waterfall, and one of the founders of Helen’s Trust – a local end of life care charity.

Together they and their team, which also includes two part-time doctors, run the rural practice which has around 4,500 patients. It’s small compared to most urban practices which are sometimes double the size but this allows them to try and ensure that they give each patient an individually tailored service, what Dr Jordan calls “cradle to grave” care.

It’s an ethos that she and her team pride themselves on, but it’s one that is getting ever harder to deliver. The Peak District has one of the oldest patient populations in the country with almost one in three of the patients aged over 65, many of whom have long-term chronic conditions.

These issues come under the spotlight in The Real Peak Practice – a two-part BBC documentary which begins tonight. Both programmes are narrated by Sheffield-born actor Dominic West, star of The Wire, whose own mother was nursed through her final days by Dr Jordan along with staff from Helen’s Trust.

Dr Jordan was initially approached by the BBC about doing a programme examining the effects of NHS changes on rural practices. She agreed and TV cameras spent 12 months up until May this year following doctors, nurses and elderly patients. Among those featured are Lord Roy Hattersley who is seen by Dr Jordan after a tumble outside the House of Lords and Deborah, the late Dowager Duchess of Devonshire.

The documentaries ended up focusing on the stories of a number of patients, including two people with terminal illnesses. “They very bravely allowed us to film them, one from their diagnosis through to their death and the other person in the later stages of life, with all the complexities that brings,” says Dr Jordan.

The practice prides itself on trying to ensure that patients who have serious, often terminal, illnesses are treated at home rather than spending their final days and hours in hospital. But maintaining this level of care is incredibly difficult.

“Across the country we have an increasingly frail population that is being cared for by a dwindling workforce, GP retention rates are falling and health services are facing budget cuts,” she says.

Dr Jordan is all in favour of working more closely with community nurses, social service workers and mental health teams, but is concerned about the future of rural health centres. “Smaller practices are becoming non-viable. There’s a big move towards working more closely together and being more integrated which is good, but as a smaller practice we know everyone and we can tailor our care to their individual needs which allows us to treat them in their own home,” she says.

“We have the second oldest population in Britain over the age of 80, and with elderly people you’re not just dealing with disease, you’re dealing with frailty, dementia and loneliness.”

Some people might not consider loneliness to be a health issue, but Dr Jordan says it is a serious problem, particularly in rural communities. “They often have very few young people because they can’t afford to live there. So they move away from their parents and you end up with an older population that is isolated and lonely.” Not only that but loneliness can trigger depression and other mental health issues.

Dr Jordan works closely with Helen’s Trust but is aware that not everywhere has something like this to turn to, and is worried about the growing pressure on social services. “They have had their budgets slashed and have had to raise the threshold for helping people. This means care is taken away from some people which means they come back to us.”

Another big concern is the lack of new GPs. “We get medical students who come on work experience and they say what a lovely place it is and how much they enjoy it, but they say they don’t want our lifestyle. They don’t want to work 12 hours a day.”

For Dr Jordan and others like her, a 12 hour day is the norm rather than the exception. It’s something that she fears is putting off people becoming GPs. “Juniors don’t want to go into general practice. In Chesterfield, we had 30 vacancies for junior doctors to train to be GPs and only four of them have been filled.”

Doctors’ working hours is a contentious issue, one that Health Secretary Jeremy Hunt waded into earlier this month when he said he was prepared to impose seven-day working on hospital doctors in England.

He argued there was a “Monday to Friday culture” in parts of the NHS, but Dr Jordan says GPs can’t work any harder than they already are. “You hear news about GPs not being available at certain times and having to work seven days, but we struggle to manage five days a week because the workforce isn’t there to provide it.”

But with demand on health services growing and the workforce reducing, can the NHS still afford traditional GP practices like the one at Baslow? Not only that, but is it feasible for patients to be able to die at home if they want to?

“It jolly well is with us and that’s what we’re fighting tooth and nail for. We had some med students here and one of them said, ‘you’ve just seen four patients with the same problem and treated them all differently.’ That’s the art, you have to understand the needs of each patient because what works for one might not work for another.”

The two TV programmes will move many viewers to tears, but Dr Jordan hopes they also give people an insight into rural GP practices and their importance to the people they serve.

“We are a small group of clinicians who really want to make a difference,” she says. “If you let someone die in their own home it’s a much better experience for them and for their loved ones.”

Surely in this day and age it should be a basic human right.

The Real Peak Practice is being screened on BBC One Yorkshire and Lincolnshire tonight at 7pm, with the second part on July 30.