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this so I have the direct contrast. But for me, the difference is this complexity. It is fun.” Similarly, back in Govan, Gillies says she has learned a lot from working in an area of deprivation. “I love working in Govan. I’ve been here about 25 years. I come from a nice middle-class background – my parents were teachers, nice upbringing and all the rest of it. But the amount that you learn about humanity and human nature is enormous.” Middle-class areas may see it as well, she continues. “It has been so long since I’ve worked in one. But we see lots and lots of unhappiness due to circumstances and I think that is what we learn to deal with.” For Mullin, working in Govan is simply a more natural fit.

“I identify with people living here. I come from a quite working-class background myself and the stories I hear are quite familiar stories, they are not alien to my ears. I think if I was brought up in social class one area and a quite aspirational family, perhaps I couldn’t get on an equal field with them. But I actually don’t see any difference between myself and my patients other than that I am now an educated person who has gone to university and got a profession.” Putting aside these differences and meeting as equals is key to the success of the patient: doctor

relationship, explains Paterson. “I think that is something we can do in general practice that is massively important, which is to treat our patients as absolutely equal human beings at a human being level.” He continues: “Tey seem to accept that there is a professional gulf, that we know more, we’ve got more money, otherwise they wouldn’t be coming to you. But it is a partnership that is based on the fact that I am a human and have been very lucky and you’re a human and you’re really unlucky. I think there is a huge role for general practice there because that then is about empowerment and that then is about worth. Tat is about self-help and betterment and sustenance and reliance. And we can start that process.” Beginning the much needed process of engagement and making these connections across the practices that work in such deprived areas has been an important achievement of the Deep End, argues Watt. Te group has met 15 times to date and has reported thoroughly on the discussions that ensued even producing a manifesto before the recent Scottish elections outlining key areas where improvements could and should be made. However, while the first meeting was jointly funded by RCGP Scotland and the Scottish Government, and subsequent meetings were supported by Glasgow Centre

for Population Health, this funding is coming to an end. Watt hopes the project can secure additional funding, however, he is concerned that their efforts will be dismissed as “a talking shop” for GPs. “Whenever I present the Deep End work to NHS colleagues, I make the point that none of them had to negotiate their attendance at the meeting with a colleague, who would fill in for them while they were absent,” he says. “But with that funding at an end, the initiative is in danger of being stalled.” Te process of meeting with other GPs

working in similarly challenging circumstances and discovering how much convergence there is in terms of the problems they face has clearly been cathartic, professionally. Tey have valued the opportunity to come together and pool their experience in an attempt to improve services for their patients, and feel they have more to contribute to the debate. “We inhabit a phenomenal position of trust in the community, which is a huge privilege, a bit worrying and very scary at times, but that is how it is,” says Paterson. “I think we have a massive political advocacy

role in this with a capital ‘P’. We are seeing this. We are living in it. We are working in it and you need to pay attention to this if you want a decent society for all.”

19 September 2011 35

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