Intended for healthcare professionals

Feature Primary Care

Recession medicine

BMJ 2010; 340 doi: (Published 21 June 2010) Cite this as: BMJ 2010;340:c3114
  1. Ingrid Torjesen, freelance journalist
  1. 1London
  1. ingrid_torjesen{at}

    With increasing numbers of patients facing unemployment and financial difficulties, some general practices are offering employment and education advice alongside health services. Ingrid Torjesen reports on the benefits

    There are many reasons why the demand for general practice services rises during a recession. People are more likely to attend with problems they would have ignored if they were working. Most importantly, people are more likely to develop physical illnesses when out of work, and unemployment has a psychological impact.1 2 Even the threat of redundancy increases sickness,3 and job loss has also been linked to increased risk of heart attacks and stroke in the future.4

    John Middleton, director of public health at Sandwell Primary Care Trust, says it is really important in times of recession for general practitioners (GPs) to recognise the impact of unemployment and job insecurity and ensure that affected patients receive appropriate care.

    “We don’t want people who are facing social and economic problems to be put on to antidepressants and psychotropic medications when their mental health problems are understandable in the context of the social and economic situation they are in,” he says. Instead, Dr Middleton adds, GPs need a range of referral routes to welfare rights, housing, and employment advice because studies have shown that such advice not only helps with everyday living it limits the effects of illness.5 6

    Niti Pall, a GP in Sandwell, West Midlands, has seen demand for consultations rise 6-10% at her practice. “We were seeing a lot of low paid workers, but now I am beginning to see many more middle class, settled workers coming in with similar problems. I have had company directors coming in and breaking up completely, people who had big businesses and who have lost everything.”

    According to the Office for …

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