Deep End GP: the view from western Sydney

What are the challenges of delivering care to a disadvantaged urban community in Western Sydney, Australia? Reath and colleagues interviewed 57 participants, some of whom felt the Australian fee-for-service model values volume over quality, and many of whom felt fragmentation of the healthcare system was a barrier to good care. The authors call for a transformation of Australian primary care to address the needs of people in marginalised urban settings. 

Antidepressants and talking therapy — who decides?

What happens when GPs talk to patients about antidepressants and talking therapy? Discussions about mental health form a major part of the workload of GPs with an estimated one-third of consultations having at least partial involvement of mental health concerns. Ford and colleagues micro-analysed consultations for depression, anxiety, and stress. They found GPs overwhelmingly leave the decision about these treatments to patients and in one-quarter the patient accepted the GPs’ recommendation. In three-quarters the patients resisted initially but ended up with the treatments, perhaps reflecting dissatisfaction with the options, but highlighting a lack of viable alternatives in the current system. 

Wellbeing of young and future GPs

There is an urgent need to increase the GP workforce but pressures on physicians are leading to burnout and problems with recruitment and retention. Lindemann and colleagues investigated the mental wellbeing of the next generation of family doctors, surveying future and young Swiss GPs. They found that high or very high stress levels were reported in almost half of participants. The findings support the assertion that doctor wellbeing is fundamentally a structural problem within health systems and organisations.