• Daniel Butler, Diarmuid O' Donovan, Jennifer Johnston, and Nigel David Hart.
• General Practice Academic Research Training Scheme, Queen's University Belfast, Belfast, United Kingdom dbutler07@qub.ac.uk.
• Br J Gen Pract. 2024 Aug 20.

AbstractBackground Living in socioeconomically deprived areas is associated with shorter lives, in worse health. GPs working in these areas face additional challenges. Aim Establishing GPs' motivation for working in these areas, what the challenges are, and insights from GPs on potential improvements and changes. Design and Setting An Interpretative Phenomenological Analysis of GPs' lived experiences of working in the most socioeconomically deprived practices, in Northern Ireland (NI), the most deprived country within the UK. Method Interviews with GPs finding out the challenges facing them, why they work in a "Deep End" area and what suggestions, ideas and solutions they have to improve patient care and GP experience at NI's 'Deep End'. Results The challenges related to wider health service failures including the increased demand on GPs and feelings of powerlessness. Patient population challenges included 'missingness', late or crisis presentations, alongside the clinical difficulties of a highly 'medicalised' patient population, as well as the high prevalence of mental health problems. However, GPs choose to work in 'Deep End' areas because it's clinically stimulating and rewarding, as well as feelings of belonging and fulfilling a duty to 'their' area. Improvements focused on providing more flexible access, increased mental health provision and future training and recruitment, particularly around widening participation in medicine. Conclusion Improving the environmental conditions, empowering individuals and investing in communities are essential to achieving health. The current model of providing reactionary acute care is leading to GPs experiencing powerlessness and feelings of helplessness at the 'Deep End'.Copyright © 2024, The Authors.

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