Intended for healthcare professionals

Rapid response to:


GPs in deprived areas face severest pressures, analysis shows

BMJ 2019; 365 doi: (Published 08 May 2019) Cite this as: BMJ 2019;365:l2104

Rapid Response:

Time to put GPs first by investing in general practice

Iacobucci paints a bleak picture of working in general practice, particularly in deprived areas.(1). However, his assessment is supported by research and various reports over a number of years highlighting the crisis.(2-6) Although we know the GP workforce faces significant challenges, we disagree that these are insurmountable, but urgent action is required.

A crucial initiative that should be implemented is the creation of health promoting general practices which would strongly support the government’s pledges on prevention, public health, and reducing inequalities.(7-9) The health promoting general practice is essentially the gold standard for health promotion.(10)

In order to become a health promoting general practice, the staff must undertake a commitment to working towards creating a healthy working environment, integrating health promotion into practice activities, and establishing alliances with other relevant groups and institutions within the community.(10)

The workplace can have an influential effect on the health of employees. A number of authors have written about the costs of ill-health to organisations
and the benefits of creating a healthy workplace.(11-13) By creating healthy working environments we feel that the working life of GPs would improve, more graduates would be attracted into general practice, and hard-working experienced GPs may stay in the profession for longer.

It is clear to us that funding in general practice is lower than current needs.(6,14,15) For this initiative to be a success government commitment and investment is urgently needed. As part of this, a national health promoting general practice award should be designed with incremental progression. At a local level the award should be facilitated and supported by public health specialists from local authorities.

Iacobucci’s article succinctly describes some of the problems that patients have to face in general practices in deprived areas compared to wealthier ones. However, it is important to highlight that some of the disadvantages that the public have to encounter are also mirrored in other settings such as schools. Schools in disadvantaged areas face the biggest problems in relation to recruitment, retention and quality of teachers.(16,17) This is particularly concerning as schools have crucial roles to play in maintaining and promoting the health of children.

Finally, it is important to state that for most general practices, achieving gold will not be easy nor will it be resource neutral, but it will be in the best interests of GPs and other staff, the NHS as a whole, and most importantly, the patients.

1) Iacobucci G. GPs in deprived areas face severest pressures, analysis shows BMJ 2019;365:l2104.

2) Goddard M, Gravelle H, Hole A, Marini G. Where did all the GPs go? Increasing supply and geographical equity in England and Scotland. Journal of Health Services Research & Policy. 2010. 15(1): 28–35.

3) Baker M, Ware J, Morgan K. Time to put patients first by investing in general practice. Br J Gen Pract 2014;64:268–9.

4) Centre for Workforce Intelligence. In-depth review of the general practitioner workforce. 2014.

5) Limb M. Increase GP trainees by 450 a year to avoid crisis, says taskforce. BMJ2014;349:g4799.

6) Watson M C and Forshaw M. TACKLING THE CRISIS IN GENERAL PRACTICE. Prioritising prevention and health promotion. BMJ 2016;352:i1333.

7) Department of Health and Social Care. “Prevention is better than cure.” London: DHSC, 2018.

8) Watson M C and Lloyd J, Re: Hancock pledges to invest in prevention to tackle “root causes” of ill health. British Medical Journal Rapid Response 12th November 2018.

9) NHS England. The NHS long term plan. January 7th 2019.

10) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

11) Tones K, Tilford S. Health promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001.

12) Faculty of Public Health and the Faculty of Occupational Medicine. Creating a healthy workplace: A guide for occupational safety and health professionals and employers. London: Faculty of Public Health, 2006.

13) IOSH. Working well. Guidance on promoting health and wellbeing at work. Wigston: IOSH, 2015.

14) Gershlick B, Fisher R. A worrying cycle of pressure for GPs in deprived areas. Health Foundation. 8 May 2019.

15) Triggle N. GP pressure: numbers show first sustained drop for 50 years. BBC News. 8 May 2019.

16) Sibieta L. The teacher labour market in England: shortages, subject expertise and incentives. London: Education Policy Institute, 2018.

17) Dept for Education. Teacher Recruitment and Retention Strategy. London: Dept for Education, 2019.

Competing interests: No competing interests

10 May 2019
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, Welwyn AL6 0UD, UK.