In the last year, over the Covid pandemic, we have been working longer and harder, and digging deeper than ever before. We pushed aside our own fears, side-lined our well-being, and devoted ourselves to overhauling the structure of primary health services, to meet the needs of our patients.
We shut our doors briefly in the first weeks of the first lock down as we were instructed to by the government, but we still saw patients face to face when appropriate. The number of contacts with patients increased massively to more than 140% of pre-Covid levels, the highest number of contacts ever recorded. In primary care we have 90% of the patient contacts for less than 10% of the funding. We managed patients who were not being seen at the hospital. The last year has seen GP staff throughout the country working 12 to 14 hour days to meet that need.
It has been a complex operation of collaboration, creativity and digital innovation. We can use telephone, text and video consultation, and unlimited e-consults, with face to face appointments when needed. In fact, the service is so accessible and the demand so high, we are drowning under the weight of that demand. Our staff go home exhausted at the end of each day, unsure how they will survive the next day, week, month, let alone the years to come.
A lot of our patients understand the situation and are supportive and polite, but many are not. It is not just the relentless work, but the unkindness, rudeness and disregard of our clinical judgement that is draining.
Not only has access been revolutionised, but general practice has also helped pull off the feat of delivering millions of Covid vaccinations in addition to their daily shifts. So many people have contributed, but without general practice staff this would not have happened. 75% of covid vaccines have been given by GP staff. Our staff man the local hub on their days off, and many of you have benefited from this.
GP staff everywhere are hurt and baffled by the media-led persecution, that pushes the concept that general practice is not doing its very best. We are hurt by the implication that we are lazy and uncaring. We have paddled desperately to keep the NHS ship afloat during the chaos of a pandemic, doing not only our own work but a lot of that of our secondary colleagues, when they have had to focus on Covid patients, and now feel stunned by people’s attitudes.
The media and some patients have focused on their right to a face to face consultation, whenever they want to be seen. Even during a pandemic. This is not a clinically sound, fair or even a physically possible expectation.
If all consultations were face-to-face, for everyone, it would come with the following problems.
1. We would be complicit in risking the lives of patients and staff by bringing large numbers of people into the building, as that would not allow safe social distancing. Would you really want to sit cheek by jowl in a full waiting room?
2. Demand is so high we would have to staff surgeries 24 hours a day, with GPs, nurses and admin staff we don’t have. In the NHS there is a shortage of qualified staff already, and more are leaving having been worn down by the stress of the pandemic.
3. The waiting time for appointments would lengthen dramatically, as appointments would be filled by people wanting an instant solution to their problem. This in turn would mean that patients with potentially serious problems would end up waiting longer to be seen, rather than being spoken to and triaged by the clinical judgement of doctors. This risks delaying serious diagnoses such as cancer.
4. A lot of face to face appointments would be filled by people who want us to sort out problems they are having with accessing hospital appointments, over which we have no control. And in some cases this would mean our staff being shouted at and abused face to face rather than over the phone, neither of which we will tolerate.
So help us to help you. Take some responsibility for your health- visit NHS choices for helpful information, talk to your pharmacist, try and manage your symptoms yourself for a day or two.
Things are difficult for everyone currently. A lot of what you and we are having to deal with is outside of our control, a complex interplay of social, political and economic factors. The pressures on the NHS are not of our making. If you take nothing from this letter but one thing, let it be this- General Practice is not, and never has been closed. Every time that accusation is made, we feel more unappreciated and disrespected. We are open, we care, and are working as hard as we can. If General Practice collapses, then the NHS will not survive.