Doctoring deprived areas

Cannot rely on exceptional people

In December Dr Matthew Lukwiya died from Ebola virus infection contracted in Gulu Hospital, in Uganda, where he worked. What made his death notable was that he was not a young doctor forcibly seconded to a rural area by the ministry of health. He had chosen to work in the same isolated hospital for 15 years in spite of opportunities to pursue a lucrative career abroad.1 In the United Kingdom doctors are not required to make sacrifices of a comparable magnitude, but there are many examples of dedicated general practitioners who choose to defy the “inverse care law” and work in unpopular areas afflicted by multiple deprivation. However, it is not possible to provide an effective service for the whole population with exceptional people, and there is growing evidence of an impending, critical shortfall in general practitioners to work in deprived areas.2

In their examination of the general practitioner labour market in the United Kingdom Young and Leese have shown that the supply of general practitioners in a given area reflects differences in local living and working environments and that the difficulties are greatest in deprived urban areas.3 Some deprived areas face overwhelming difficulty in recruitment—for example, mining valleys in south Wales—whereas deprived areas in smaller cities face fewer difficulties.

Although the British government has made a commitment …