Healthcare for Disadvantaged Communities
A Really Interesting Care From Primary Care
General practice brings different flavours of people, temperaments, and challenges. This is precisely what makes primary care so appealing—there’s always something new to consider.
This is especially true in my work in an ethnically diverse area, where I see people from all over the world. I encounter patients who speak different languages, have varied education levels, and come from different socioeconomic backgrounds.
My average surgery often includes patients with different health beliefs, people who struggle with reading and writing, and those who have no fixed abode.
As a practice, we have to be quite creative to ensure that patients aren’t lost to follow-up. Here’s an interesting case I encountered:
A 29-year-old Gypsy Traveller woman, who was 16 weeks pregnant, presented with high blood pressure. She had no protein in her urine (as per the midwife’s check) and was less than 20 weeks pregnant, so technically she was not classified as having preeclampsia. Her midwife had sent an email informing us of her blood pressure, as she had DNA’d many of her appointments.
I had a telephone catch-up with her, during which she mentioned that she was a Gypsy Traveller. She explained that her family moves to different areas every few weeks and that she struggles with reading and writing. She had been taking Aspirin as prescribed by her midwife but had not taken any recently. She was unable to come to the practice to request a repeat prescription due to the distance, and it was likely she would be moving across the country in a few weeks. This was definitely not a straightforward case.
In reality, this patient required the midwife to see her in order to commence treatment, but I knew I might not see her again. I asked her to wait outside and called the midwife, who recommended starting labetalol. I performed a blood pressure check, measured her pulse, and explained the role of labetalol.
It’s likely that this patient has chronic hypertension, regardless of her pregnancy. High blood pressure was an incidental finding on her booking test, and she had several risk factors (smoking, high BMI, etc.). Could I get a home blood pressure monitoring (HBPM) reading from her? That seemed unlikely. I decided to code her as hypertensive based on the few blood pressure results we had and arranged to obtain blood tests, an ECG, and an albumin-to-creatinine ratio (ACR).
I took the bloods myself, which didn’t take long as she had good veins. I asked the practice healthcare assistant (HCA) to fit her in for an ECG. Regarding the ACR, I gave her a urine sample pot but accepted, in the back of my mind, that we might not receive this result. However, she definitely needed some form of follow-up after moving away from the area.
So, how do we ensure access? I spoke to one of my colleagues, and together we implemented some useful interventions while she was registered with us:
Registering the practice address as her residential address: This ensures that all correspondence from the hospital, midwives, or the surgery itself is sent directly to the practice. This allows her to make scheduled trips to collect her NHS mail.
Communication via phone calls: Since the patient mentioned that reading and writing were difficult for her, we added a prompt on her record recommending phone calls or voicemails to improve communication and accessibility.
Larger supplies of prescriptions: As she was prescribed labetalol and aspirin, we increased the quantity of medication supplied with each request. We also set up automatic renewals for the duration of her pregnancy and asked her to inform us of her new location so her prescriptions could be redirected to a local pharmacy.
In the end, the patient was very happy with the outcome of the consultation. Patients have their own unique circumstances, and while we might expect them to adapt to prioritise their care, unfortunately, it doesn’t always work that way. There are many disadvantaged groups, including those who are homeless. Over the next few years, it’s likely that the NHS app will expand to improve access to care, and with advancements in health technology, we should see more innovative solutions.
Have you ever had a patient for whom you had to think outside the box? Let us know…
How do you feel about Neurology?
Neurology is not easy and is certainly a topic that many clinicians find difficult to apply in clinical practice. Join us for 3-hour course where Dr Elniel (specialty registrar in neurology) will present an engaging presentation on core topics in neurology. These include:
Principles in neurology: history taking and examination skills
Primary and Secondary headache disorders: strategies and emerging treatments.
Stroke and TIA management: signs, presentation and management/referral.
Movement disorders including Parkinson's disease and MS diagnosis in clinical practice).
FND and referral criteria.
Suitable for qualified clinicians and student practitioners.
Date: 29/06/2025
Time: 10am - 1pm. This CPD will be RECORDED for future access
Externally accredited CPD certificate (THREE points)
How To Deal With an Angry Patient?
Dealing with Angry Patients? We’ve all been there. The key is to stay calm and stay professional.
I wish it was as easy as that. In this video, we give you practical tools to manage emotionally charged situations with confidence, empathy, and clinical professionalism. Many of these situations are as a result of assumptions and unrealistic expectations from both sides and it takes effective communication to solve such situations.
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