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At the heart of general practice since 1960

Practice profile: Most deprived patient list

Dr Simon Abrams explains how he runs a zero-tolerance practice in the Everton district of Liverpool, which is officially England’s poorest area

Dr Simon Abrams-online-full

Name Great Homer Street Practice, Everton, Liverpool

List size 2,450

Full-time equivalent GPs 2

According to the index of multiple deprivation from 2011, our practice serves the most deprived population in England.

We have a high incidence of several diseases, particularly cancer and COPD. Many of our patients smoke, or have smoked, and there’s a very high incidence of lung cancer among the local population. At one point, mortality rates for lung cancer in the area were three times the national average.

We run the Violent Patients DES.

Patients sometimes get angry, swear and have challenging attitudes towards staff. Mostly this is because of health anxiety. I’ve observed an episode where a patient put a chair through the waiting room window, but he took great care not to hurt anyone when he did it. There are a few who kick off at staff to try to manipulate them. We need to provide these people with healthcare, but we also need to protect other patients and staff.

We are a ‘zero tolerance’ practice.

Sometimes we have to call the police. We’ve seen two patients convicted for abusive behaviour and damage to property in the past two years. But even if we press charges we will still have them back – both the patients who were convicted are still registered with us.

The biggest challenges for GPs in this environment are ensuring all staff members feel safe and secure and being able to keep providing care.

We are quite training-focused at the practice. Recently, we’ve done a course in de-escalation training with a former policeman. We learned that the three main ways to prevent an angry conversation getting worse is to make sure your body language is not aggressive, your tone of voice is calm and your are listening carefully to the patient so you can understand what they’re anxious about. It’s not just about agreeing to whatever they want.

As well as having the skills to work with angry patients, we also have suitable premises.

A training module our team did a few years ago educated us on the fact that people will use whatever is to hand as a weapon – which, when you look down at your desk, helps you notice how many sharp objects we normally leave lying around.

We have extensive alarm systems in the practice. There’s a silent panic button on the phones and computers that tell staff if there’s something going on in a particular room, and in which room. We also have a ‘major event’ button that sets off all the fire alarms in the building, but thankfully have never used it. In fact, the last time I used the silent alarm was by pressing it with my elbow by mistake. I think it gave my trainee a fright.

We have a community matron and health trainer.

The community matron does home visits and helps patients who have social needs, such as housing, as well as health issues. The community trainer comes in for a half-day each week, and provides five half-hour sessions to help patients improve their health – by quitting smoking, cutting down alcohol consumption or losing weight, for example. She’s also improved diabetes control for several patients. We’re excited by the possibility that the CCG might offer to double the number of hours our health trainer offers. NHS Liverpool CCG really supports our work – we don’t need to join a federation to protect our business, and I’m not aware of anyone in Liverpool who does.

The best thing about the job is getting patients’ appreciation.

We work in an area where there’s a lack of opportunity, be that jobs, housing, education or environment. There’s a lot to do here and it’s challenging but patients are respectful, and often say ‘thank you’.

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Readers' comments (19)

  • "The best thing about the job is getting patients’ appreciation."

    What a sad life!

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  • No - it is not a sad life - keep it up Simon. You have my admiration and respect.

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  • To the anonymous partner who posted above.

    These challenging patients have probably never appreciated what a health care professional has done for them, so for a doctor to break down the barriers and work with the patient so that they end up showing appreciation is a difficult task. Dr Abrams obviously works tirelessly to achieve this and understandably gets satisfaction from making a difference in a patient's life. Then once those barriers are down it makes it easier to deal with the underlying health matters.

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  • This comment has been moderated.

  • My previous comment was moderated and part of it removed. It seems that it's ok for a post to insult the Dr in the article but when I question the poster's comment and his/her motives for being a GP then it's removed.

    So in response to the first post who commented 'what a sad life' I'll just say -

    We need more GPs like Dr Abrams, not you.

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  • Azeem Majeed

    A very interesting article. I hope that NHS England and the local CCG provide Dr Abrams ' practice with the support it needs.

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  • I can see exactly what the first poster is getting at.

    Not to undermine the good work of so many excellent GPs (myself included!), the profession has become the very essence of bland acceptance of all negativity and insults hurled at us, which is largely the reason for the mess we are in.
    Our so called 'leaders' certainly adopt this stance.

    It would sometimes we more representative of the true situation if GPs had the bottle to actually say things as they really are, than suggesting for whatever reason that all things are wonderful and the job is great (which it is not).

    I don't think many GPs would currently state that the job is made worthwhile simply because of patient appreciation.

    Much of the job stinks, and even with appreciation, that doesn't change.

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  • Vinci Ho

    Personally know Simon.
    Obviously some well done work but he also highlight the fact federation is not necessary in this case and probably a corporal approach will not work . What is necessary is though more targeted resources , something these politicians will never fully understand .

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  • Vinci Ho

    Correction
    corporate approach

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  • There are some GPs who are so inflicted by the messiah complex that they can no longer see the wood for the trees and because of them and their accolytes in the RCGP the entire profession is being shafted up the jacksie.You can't blame it all on Hunt.

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  • isn't this what is best about uk GP.

    Yes it is being targeted and destroyed but that is not simon's fault.

    You need to have this as an example of a good practice

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