The pale young woman drew her thin Urban hoodie around her and leaned forward in the chair. Her eyes were dark, her hair dropped forward. Her skinny jeans and flat shoes were no match for the weather.
It's Monday morning and she was Doctor Greenshields' 9th patient of a morning not even half done. She had ten minutes and the clock was running. Greenshields flicked through the system, scanned it; two children (did the maths) under seven, occasional visits for coughs and colds, the odd clinic with the kids. Not a 'frequent'.
Greenshields studied the woman... but for the happenstance of life, she might have been Sarah James. Sarah's dark eyes had a knowing look. She had seen a side of life that Dr Greenshields would never experience. Sarah would not know, she and the doctor were born twenty miles apart, on opposite sides of the city just three years difference.
'How can I help?'
'Well, I've got a bit of a cough', she reinforced the symptoms with a wheeze.
Eight minutes left; stethoscope... listen... it was obvious. Her visit was nothing to do with the chesty cough, or even the smoking that was the aggravation. Her blood pressure was high and she was painfully thin.
As the minutes ticked by the story tumbled out. Back in the summer Jason had lost his job, they got behind with the rent on the flat, there was a problem over benefits and claiming and forms. The landlord wanted the rent this week. Mum had lent them some money they had no hope of paying back. It was Mum's Christmas money and when her partner found out he had a row with Jason and called him a lazy &^%$^$#.... she didn't want to say the word.
Dr Greenshields nodded.
The head teacher wanted to see them both about the older one's 'behaviour'. Jason wouldn't go and there had been another row. She hadn't seen him for a week. She thought he was staying at his brother's place. She was frightened to go there and there we no credits left on her mobile... and the machine was broken so she had nowhere to dry the washing... and she burst into tears.
Four minutes left.
Doc Greenshields moved the tissues across the desk. Through the tears Sarah got to the point. Could she have some of the same pills her sister was on, to help her get by?
What Dr Greenshields wanted to do was to call the landlord and tell them back-off. See if there was a school nurse and what was known. Call social services and alert them. Make an appointment at Relate and give Jason a good talking to. She wanted to bang the heads of the job centre and benefits people together.
Ninety seconds left. She filled in a form for the food-bank at the church and...
Antidepressants are taken by more than one in 10 women - double the figure for men.
Primary care is in crisis. Not enough GPs, the ones we have are rushed off their feet and no real prospect of resolving the workforce problems in the touchable future.
Regulators continue to pile on the agony, no one has any idea what to do about demand and the crackers policy is to give GPs more work because hospitals are, busy... like primary care isn't.
The impact of the squeeze on the economy is really, only now, being made manifest in the lives of ordinary people whose health needs start a long way from the practice front door. Health inequalities that can define a life's chances by a few miles on a map and blight a sure start for the kids. Public health powerless to bring MPs to account for their neglect.
Primary care is in crisis. What is a realistic future?
I want to know. The clock is ticking...
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If you want to know, too, join me, the NHSE Primary care Tsar and Deputy Medical Director Mike Bewick, leading GP Dr Clare Gerada and the president of the NAPC and former policy advisor Dr James Kingsland, at the Kings Fund for a night of
The Big Conversation about Primary Care.
Details here.
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