Patient encounters in very deprived areas.

Series difficulties in moving beyond reactive patterns of patient and practitioner behaviour. The incentives of the Quality and Outcomes Framework do not reward practitioners for extending consultations beyond a narrow range of targets and the QOF agenda, highlighted via computer alerts, can be felt as an intrusion in the consultation. Current NHS initiatives concerning patient self-help and self-management appear to have poor penetration in deprived areas and were not recognised by practitioners at the workshop. Consultations are more likely to be successful if carried out in a systematic way, establishing the patient's agenda at the outset, picking up clues ('psycho-social red flags') and ending with clear agreement as to what has been decided. Surgeries (serial consultations) can be made more efficient by good practice organisation, involving clear communication and the involvement of other members of the team including receptionists and practice nurses. A frequent and important aspect of many consultations is referral to other professionals and services. Referral is most likely to be taken up when it is quick and to a familiar local setting. When a referral is made outside the practice, some patients would benefit from additional help and reminders to increase the probability of the referral being taken up. Practices provide a hub for referral to a huge range of other professions and services. Many of these pathways are dysfunctional, with poor communication and feedback. Multiprofessional working across organisational boundaries works best via established relationships with named individuals, with regular, reliable contact and opportunities for professional exchange. Practitioners are keen to make use of the full range of possible services and sources of help for patients but frequently lack accurate and up-to-date information about what is available locally. Patients also need ready access to health information and resources available within the local Early in the Deep End project, 15 GPs met for a workshop on patient encounters in very deprived areas, drawing on experience, evidence, and policy, and focusing on what can be achieved and how. Consultations with patients are the largest and most important part of the work of GPs. In severely deprived areas, consultations are characterised by multiple morbidity (including psychological and social problems), reduced expectations, time constraints, lower patient enablement, and practitioner stress. 1 Consultations always address the problems presented by patients on the day (reactive care), but can also address potential future problems (anticipatory care). A key aspect of the consultation is the …