i have not man i a charter or i dream about things are home to me when i was a kid i wish physically or sexually abused are not now hot on living with a star shark but hannah suffered a nervous breakdown in her twenties and spent years in and out of psychiatric hospitals. know well enough to live within the community she's completely reliant on the state for her health housing and welfare needs. dr melanie gardner has her first port of call for any health concerns i like her because she's our she make me laugh she makes me smile i don't just see it as a doctor a she was a friend of our which is nice to not mean you get a good relationship your doctor makes a whole lot different. primary care looks after ninety percent of all patients experiencing mental health issues in the u.k.

they make up a quarter of all consultations but not point men are past ten with dr gardner if you took a glance at hanna first off you think well she's not that well can't. i wonder what this person's all about. but if you can find something in that person that you connect with or you can identify with then everything else can kind of follow from that. other. i mean. i've had a really bad place on anything other than not measurable increase in value but it's way ok i can shuffle vanished like history book myself if they are you falsely bad and you know i caught a number cade and you scared ok on petrol hard. so this week cash has it been that you all that the nightmare is a worse in themselves and more scary or is it that you're having the morning k.

me or mark a week can i just ask what you do when you wake up come up like a shaky maiden a word you're sort of panicky you really have been running i was reading a diet book the other day ok we're now on my way and i'm not i'm not for you from a right way and in the diet book i had a whole list of things you can do when you're not allowed to the yet obvious. is to control your eating but to distract yourself it's things like do a puzzle leaf through a catalogue call a friend do you know nails and screws loose i don't think you're taking this very seriously you know who thought you know i read this list of things that distract you and i thought of you and i thought actually maybe this list might be helpful for you to look at a problem shared is hard it really does help to talk about things and just to feel listened to and feel that knowledge i didn't do that much today for example with honor and talking about her past abuse i didn't do any big psychological

intervention we didn't go into it really in any detail i tried to encourage her to be distracted the most important thing i did was say oh that's awful and listen and i really acknowledge what she was. telling me and how awful it was and i think that that's probably the most support thing i did thank you ok thank you see this is a very self and don't do anything are coming. bye bye bye bye it gives me the confidence to come i am confident that for in make you need a competent building when you've gone for a walk all you need to kompas building and she get meat out of it and mentally ill people often find it very hard to access health care they may be scared of institutions or going into a hospital if you're quite a vulnerable fragile person can be very threatening by providing doctors and nurses that they can get to know we can encourage people who are quite vulnerable to be able to access health care in a way that hospitals. struggle today. the

network of general practitioners free to visit at the point of need the yuki's health system one of the most accessible in the world for its citizens. it also saves money they keeping out of hospitals we are sort of one of the front doors of medicine really there's anybody two front doors one is general practice and one is a any. one of the. each appointment with a general practitioner because the health service thirty one pounds or forty eight dollars. is attending the x. intern emergency remark is about four times that at one hundred ninety one dollars . killick street has an average fifty three thousand five hundred appointments pay a year each schedule to only ten minutes. we have a lot of training in dealing with problems in ten minutes the challenge comes when either it's a very very difficult problem very complex you don't know what's going on as

a doctor so we have the ability to refer patients in to see a specialist or go for a test or whatever it may be patients can't really get into those systems without seeing the g.p. patients can only see a hospital specialist with a general practitioner or a feral each for a feral costs between two hundred fifty and three hundred ninety dollars. so there's a lot of pressure on us to make sure we use that in the right way really in a system which is stretched we have to justify that we are using specialist services appropriately louise for comfort dr ben smith patient louise has come to ask him for feral. pay to. have. affairs here it's here we spoke you said that in the solar cell which has you know this housing but how about all mine for too long you know down into it so movie

on the move you referred to i've been seeing it the vast majority of the ferals like those at celtic street are based solely on the doctor's clinical judgment. but recently some practices have been rewarded for non referral by the local health authorities in an effort to cut costs where the hope ability service has the right thing i don't know i don't mean a level where services is that you know is it where is it reviewed it is actually pretty quick it's the internet and monitors e.c.a. so out which is. what i mean i can have a little bit of a look into that service and see what the sort of criteria are for getting there but i suspect it's quite severe quite eerie but what often will be for me to refer you to was called the most fiercely course they will know about high probability service and they are able to refer you in start or suggest to me the tide of food into that i have read a few i'm following you off with that now it sounds like maybe i kind of didn't

think. well i was a hey it's microfinance that i've been seeing you probably do appreciate that you know this is a very specialized thing and. coming through jump through hoops to fail you know maybe yeah that's right they appreciate. there is a what is my theory so we should hear it in a clinic in a few weeks we have within four weeks or so posters. were right on it. thirteen million referrals are made in england each year a number that has increased by four million in the last seven years. patterns are monitored and they're compared to other practices so we do see data where they were more or less another practice says you don't want to practice that over because that suggests that you may be not doing enough in primary care. the

work of general practitioners is monitored by their local clinical commissioning group this is to ensure best medical practice in their area. national bodies such as the national institutes for clinical excellence produce guidelines to inform g.p.'s decision making particularly when it comes to prescribing medication. it really is the change to do you. actually see willing to cheat we all struggle with the. and i was the last one hundred last time coming. back you four legs yes. you did want to come in it was worse but still be chilly here we're careful about prescribing not so much because people check up on us but the because we want to do best practice we want to follow national guidelines yes and in no time.

cream up forty five miles or so moisturizer cream we've got you down to see the macro go we don't do a forty five i don't spray cans with our all the stress we have to do that usually what you think of the best god is good but if you don't like that one ultra bases are nuts and i said you must arise in three you know how i am about there's no evidence that says any particular difference between which moisturizing you create you cream use and another they're all very much the same local prescribing advisor t. want us to prescribe the cheapest what. cream and that's going to save one pound fifty four ok i think one pound fifty for not very important times that by hundred thousand people we can save hundreds of thousands of pounds by prescribing the cost effectively. i'm going to visit one of my regular patients. who normally comes the surgery actually but she's been quite ill recently she's got

a very nasty skin condition according epidural lysis below. which means she has blistering skin all over her body sort of on. her box but also inside her mouth around her eyes as well and she's had a flare up recently which means shipping lots of pain and. she's unable to come to the moment it is a life limiting condition. it's a fine balancing act by saving resources where they can general practitioners are able to add. more to those in greater need or highly feared bands where. banks. hi there hi yeah yeah and if it not too bad well i was in arctic that will heat and stiffening a month or so i was you know more or less on the bags i can even stand up to get

into the chair and at the end of last week i was feeling a bit better in a bit more and so modelling i wasn't really hurting so much late last week when my friends were asked to go to this event and i was so kind of store that had to find that because food when the condition of the day it's a well i'm always. chosen the kind of cider that's kind of that has been that because i start to feel ok and anyway ok so in terms of our sort of we can catch up with aggressive medications or anything you need me to sort out for you at the moment. but it's ok and mostly interest here sky and the shift over the last few years think us. bench role is to coordinate the kiraly she gets from various hospital specialists in particular it's his job to prescribe the expensive medication that she needs. well i'm aware that with many people really can be into hundreds of thousands. and. i mean it can't be

helped and there's not much good looking he was is in a cheap p.c. that what we have now and nothing this is really an opportunity who should be much worse i'm not here are now and i've hardly seen the humorous would be around a bit because you can see what you write it's a nice to see it anyway because i can help you sort of. medication is very very expensive so why of course if you conversations between prescribing advisers about . the people who monitor our drug use want me to you know want to be clear that a medication is used properly because they can turn about the cost it cost thousands of pounds every month i'm not quite sure how much but it. is a lot but chiefly the needs of. meeting the medical needs of the u.k. population is an increasing challenge. since it has been found that

the population is growing the population is a lot more people older people sicker people and people more worried about what's wrong with. less people a path to pay more tax and it's just not going to work you called far more invasive and expensive treatments on the same on the left people are willing to pay more since the birth of the n.h.s. life expectancy has risen by thirteen years the population has grown by fourteen million and medical knowledge has advanced an unimaginable ways the pressure placed on primary care is building whether it can survive in its current form hangs in the balance and the strangest living or actually been asked to stop treating the n.h.s. like a political football and changing the rules economic time the government changes or more.

as europe's public opinion shifted to slavery is admission there for you where human exploitation took on new homes as a whole slate that became the hidden face of europe's industrial revolution the history of slavery is not a black history and it's not just the history of white colonization but the history of human equality is the legacy for all of us the slaveries new frontier in this part three of slavery the world's. deported from the u.k. indoctrinated by somalia. how can a young man this illusion by five rebuild his life as a mixed race going to make a mistake they are killed and reunite his family after the case no not call me off my kid lost warrior a witness documentary on a jersey i can't say. i

mean this is different it's whether someone's going for someone's favorite. trick i think it's how you approach it is a certain way of doing it you can just. get a story and fly out. as we embrace new technologies rarely do we stop to ask what is the price of this progress what happened was people started getting sick but there was a small group of people that began to think that maybe this was related to the kind of this closure in the job and investigation reveals how even the smallest devices have deadly environmental and health costs we think ok we'll send waste to china but we have to remember that air pollution travels around the globe death by design on al-jazeera. alarm has in doha the headlines on al-jazeera airstrikes has struck syria's

province killing at least seventeen people russia says it knows the syrian army is planning an offensive on the last rebel held bastion the u.n. is warning of a humanitarian disaster on a scale not seen in seven years of war the u.s. ambassador to the u.n. says it will not tolerate a chemical weapons attack on a live what you're saying from us and the fact that the security council wants to talk about it is do not let a chemical weapons attack happen on the people of it lead the people of syria have been through too much this is a tragic situation and if they want to continue to go the route of taking over syria they can do that but they cannot do it with chemical weapons they can't do it assaulting their people and we're not going to fall for it if there are chemical weapons that are used we know exactly who's going to use them and this is the exact same playbook that russia and iran and assad have used every time

a ceasefire has been reached between armed factions fighting over the libyan capital for more than a week more than sixty people have been killed and one hundred fifty injured under the deal all fighting with end the city's only airport will reopen at least ten people have been killed as typhoon gerri batters japan the government as issued evacuation advisories for more than a million people and canceled hundreds of flights gebbie is the strongest typhoon to hit japan in twenty five years a new book by washington post journalist bob woodward says u.s. president donald trump wanted to have syrian president bashar al as said killed last year his defense secretary ignored the request the book fear trump in the white house has quotes from the president's own aides questioning his ability to lead the white house says the book is in its words full of fabricated stories. the leaders of pacific island nations have been meeting in narrow that's where australia as an offshore prison camp for refugees for

a forum is focusing on regional peace and security and improving the health of the olives people but the prison camps and the treatment of the refugees there is casting a shadow over the conference around one thousand six hundred people are held in two camps one in now the other on papua new guinea's mannus island those are the headlines we're back in half an hour right now it's back to the people's house september on al-jazeera the fourth eastern economic forum is to be held in the city of bloody post-doc as russia looks to expand its influence in the asia pacific region on television and online the street continues to tap into the extraordinary potential of social media to disseminate news the presidents of russia turkey and iran will meet in teheran for another summit seeking an end to the war in syria we'll have extensive coverage people in power continues to examine the use and abuse of power around the world the united nations general assembly hold the

seventy third session what action will it take on atrocities in me in march and yemen will bring you all the news september on al-jazeera. primary health care is the cornerstone of the u.k.'s national health service funded by the taxpayer it's a model for countries wanting more accessible and affordable health systems and it all hinges on a network of local doctors i really find it interesting meeting people who get to me only as interesting people and you get to ask them personal questions about and i was and find out.