Primary Care From A GP Perspective!

One of the biggest recent crises that we are facing is the issue with seeing a GP. Like many, I am sad to see this being dragged through the gutter press, causing abuse to so many members of the #NHS. Without doubt it is something that needed addressing and I’d like to thank my great friend Dr Simon Hodes for sharing what things look like from his position. This post is longer than normal, but it is important to understand the facts, not the gossip.

There are many triggers for anger; such as feeling a loss of control, being made to wait too long or forgotten, feeling as if your voice or opinions are not being heard, having your goalposts moved for you – or being unable to keep up with rapidly changing events. The Covid Pandemic has forced sweeping and rapid changes to our lives – probably no more so than within healthcare and the NHS. It is easy to understand why patients are so upset and angry now. The ‘honeymoon’ period of sympathy for overstretched NHS and social care staff with clapping on the doorsteps, NHS discounts in many shops, free gifts and food has all but disappeared. In its wake, NHS staff are now experiencing unprecedented level of abuse on a daily basis including bomb threats, hate mail, graffiti, verbal and physical attacks.

Recent data of 2400 doctors from a BMA survey in July 2021 showed that over a third (37%) of all doctors had experienced abuse in the preceding 3 months. Sadly 96% of these attacks are directed towards reception staff. Two-thirds of GPs (67%) said their experience of abuse, threatening behaviour, or violence had got worse in the last year, and the most common place for abuse experienced by GPs was in their consulting rooms (53%). This is very worrying as GPs are usually working alone. A survey of 1250 doctors by the Medical Protection Society in October 2020 also reported high levels of abuse towards staff, with over a third saying they had experienced verbal or physical abuse from patients or relatives.

While these results are very concerning, they may not come as a surprise. General Practice deals with 90% of all NHS contacts – with over 300 million contacts per year (compared to 23 million visits to Emergency Departments) – so any change in access or service delivery will be most acutely noticed at a community level. Under NHS directions, GPs were told to go ‘digital first’ to protect patients and staff, and also to triage all patients before making a face to face appointment (where clinically appropriate). Despite following this advice, GPs have been criticised heavily for being ‘closed’ when nothing could be further from the truth. To rub salt in the wounds, the Daily Mail and The Telegraph have been running a series of headline articles demanding a return to face to face consultations.

This is simply naïve, unsafe and unrealistic. Although not talked about much, from the Doctors perspective phone appointments are far less satisfying in many ways, often take longer (as we have to spend longer double checking safety questions), more risky for us (as we cannot see our patients to lick up all the non- verbal clues), more likely to lead to complains and more tiring. We were never trained to work this way at medical school or as junior doctors, so it is a brave new world for us too! Some of the ill-informed media narrative berating us for using phones more is tiresome and insulting.

Oddly, while patients seemed to largely accept cancelled hospital clinics and remote reviews, there has been a lot of public frustration and anger lodged towards GP teams . This perception of “GP being closed” was fuelled by false rhetoric from some media outlets, many social media anecdotes, comments from politicians and most surprisingly from several letters from NHS England itself telling GPs to offer face to face appointments. Journalists actively seeking examples of poor practice to denigrate the entire profession might be doing more harm than good.

In reality, satisfaction with GP services remains remarkably high year on year as evidenced by IPSOS Mori polls . The recent BMA survey shows that abuse against NHS staff is rapidly escalating in frequency and severity. The impact of this on the workforce cannot be underestimated in terms of morale and wellbeing. NHS staff have a right to be treated with the safe courtesy and respect with which they treat their patients. Acts of abuse, violence, and threats are totally unacceptable and should not be tolerated. What can be done to help? Here’s a few suggestions

1) Please try to be kind to those people trying to help you. A smile and a few kind words go a long way.

2) Please feedback good service and good care. It is human nature to feel strongly when you are upset and make a complaint – yet it is far less likely for people to post a positive review. You can post a review on the NHS choices website (this is a link to ours for example) and this acts a bit like the NHS trip advisor.

3) If you are unhappy please use the formal complaints procedure. This will be readily available. Please do not direct your anger at individuals in the heat of the momen t. Please treat all staff with the same degree of courtesy and respect as you would like to be treated yourself.

4) If you need to contact your GP – think about the best way to do this. Call 999 in a severe emergency only. Phone your GP or 111 for same day appointment (NB the 111 service can book you in with your own GP now). For anything non urgent please try your local pharmacist, the NHS app or send an eConsult (secure web form) from your GP web site and they will usually respond within a few working days. Check results and order meds online where possible. All this keeps helps keep your GP phone lines free for those people who really need to get through and of course those who are not digitally savvy.

5) Always be prepared for your appointment to make the most of your time. The vast majority of problems can safely be resolved without seeing someone face to face. If you think your problem needs a face to face appointment for any reason you should always request this politely.

6) Understand the reasons why you might not see a GP . Problems can often be dealt with by other health care professionals (eg nurses, pharmacists, paramedics and physicians associates to name a few) who are now routinely embedded in General Practice teams. This does not mean that your GP does not want to see you . It is simply because of the excess demands now, and a national shortage of GPs, that those remaining GPs tend to be dealing with the more complex cases and also supporting and training all the other team members!​

7) Remember that on top of everything else, GP teams have delivered over 75% of Covid vaccinations . GP teams are also responsible for recalling the correct high risk patients for covid boosters and the extended flu vaccine campaigns.

8) Please note there is a well-recognised GP crisis . This predated the pandemic but has been exposed now. Please do not make NHS staff the scapegoats for decades of underinvestment. The UK was promised 6000 more GPs years ago, but full time numbers are falling instead. Many GPs manage up to 70 patients per day now. The maximum safe recommended level of contacts in a full day is around 25 . For UK GP now the volume of work is simply unsafe for patients, unsustainable and unfair to GPs, and will ultimately result in staff sickness, stress, clinical errors and complaints. Please consider writing to your MP to express your concerns about the state of the NHS and the unsafe volume of GP workloads. Or simply add your name to this BMA petition .

9) Many people now have private GP access as part of health insurance . If you are lucky enough to have access to this, you might find this works well for minor illness, muscular problem, and skin complaints or to arrange a private referral. This might be easier and quicker than trying your NHS GP and will of course also free up pressures on your NHS GP.

10) Urgent action is needed to ensure that all staff feel supported and safe in their roles; particularly those in reception and those clinicians working alone with patients. With over five million patients now on waiting lists, and increasing demands on the NHS which are likely to surge again as schools return and over the winter—the strain on the NHS is only likely to worsen.

Above all we must continue to remember that we are all human beings. NHS staff are exhausted after 18 months of fighting the Pandemic. NHS staff are nearly always trying to do their very best in extremely challenging circumstances, many often working long, antisocial hours for very poor pay — so please try to be kind and considerate when contacting your GP surgery or dealing with any medical staff. A smile and some kind words go a long way. Simon Hodes is an NHS GP partner in Watford, a GP trainer, appraiser and LMC rep. Twitter: @DrSimonHodes