Young doctors take up a city challenge

New medics are gaining experience with GPs in deprived areas.

Inner-city Liverpool may have discovered a solution to the mounting problem of recruiting family doctors to work in inner-city areas. Since 1993, a pounds 1.5m scheme, set up by the former Mersey regional health authority, has recruited 16 newly qualified family doctors to work alongside established GPs as salaried "associate physicians", practising in some of the most run-down and deprived parts of Liverpool and its surrounding towns such as Sefton and St Helens.

The doctors spend three years on the scheme, which not only provides them with experience of working in inner cities but also offers a personal development programme which, over a half-day per week, teaches them about personnel issues, managing a practice, how relations with health authorities work and gives them extra clinical training.

Most of the doctors work with single-handed GPs or in small partnerships, helping to train practice staff, setting up new services, and taking over some of the existing GPs' workload. That in turn frees the established family doctor to undertake further education or to develop their practice themselves, introducing, for example, health promotion clinics.

"The scheme has led to many new clinics and services being established," Dr Roy Woodward, the scheme's co-ordinator says, "and it has boosted immunisation rates and cervical cancer screening in deprived areas with high levels of illness.

"A lot of these practices have had great difficulty in achieving high rates of screening and immunisation because it is difficult to get people interested - whereas in more prosperous areas they come pouring through the door. But a lot of this is about getting the systems set up in the first place - something single-handed GPs have often found it difficult to find the time to do. Now, however, most of the practices have reached the higher target for immunisations and screening.

"Once set up, however, these systems are relatively easy to run because a lot of the work can be done by other members of the health care team. So the aim is that the extra services and clinics will continue when the associate physician scheme ends."

The big bonus, however, has proved to be that some of the associate physicians, having experienced inner-city life, are opting to stay, joining practices as full partners. Two of the first four doctors recruited have decided to do so, along with a third from the second intake. "But for the experience of our scheme, they would never have considered working in inner city areas as a first option," Dr Woodward says.

Many newly qualified GPs, he argues, would benefit from spending some time in the inner city before making a life-time commitment to one practice and buying into its bricks and mortar. The extra training they receive benefits them wherever they finally go, deprived urban areas gain from their services - and some decide to stay.

Dr Diane Exley, 30, is Barnsley-born, Glasgow-trained and did her final GP training in Ambleside in the Lake District - an experience about as far away from Toxteth as it is possible to imagine. She is one of those who decided to stay on, joining a practice which handles some of Liverpool's homeless and hostels.

"I never envisaged I would ever come to Liverpool or any other practice in a big city," she says, "because from the outside it is not very attractive to most GPs. It is a high workload, the patients are more demanding, there is more visiting and inner city GPs tend not to make as much money. I assumed I'd go for a suburban practice." Her experience, however, has convinced her that the work is rewarding.

"Although the patients are more demanding, the problems they have are real. You can see the need for health care." The scheme "has given me confidence, given me the training I needed, provided a different insight on inner city working - and provided extra education as well."

A full evaluation of the project will take place next year as the last of the 16 doctors complete their three-year stints. Then it will be down to the local health authorities whether to continue it, although Liverpool Health Authority has already adopted the idea.

Something that encourages GPs to work - and possibly stay - in the inner cities is badly needed, says Dr Woodward, who last week presented details of the project to Gerald Malone, the Minister of Health who is drawing up options for developing general practice and for addressing what is rapidly becoming a national crisis over GP recruitment and retention. The number of GPs under 35 has been falling, far fewer doctors are entering vocational training to be a GP, and a national recruitment problem "is much more serious in the inner cities," he adds.

"A lot of people coming out of vocational training feel they are not fully equipped to go into general practice. There is a lot of uncertainty about what the future of general practice holds. By offering not just experience of inner city general practice but a personal development programme attached to it, we feel this does something to address the problem," Dr Woodward says.