GPs are on their knees - stop blaming us for the NHS crisis, Bath GP tells PM

A Bath GP has told prime minister Theresa May to stop blaming the profession for the NHS crisis, warning in a post on his practice's Facebook page that general practice is on its knees.

Number 18 Surgery GP Dr Charlie Berrisford wrote the message after being infuriated by comments this month from a Downing Street adviser suggesting that GPs were contributing to pressure on A&E by failing to offer the access that patients need.

Patients responded in support of the GP's post, backing his rejection of the government's portrayal of 'lazy, greedy' GPs.

Dr Berrisford pointed out that general practice is facing huge pressure from an ageing population, declining funding, a growing recruitment crisis and soaring indemnity fees - and warns that there is 'no physical way' his practice could deliver a 12-hour-a-day service seven days a week.

GP workload

He highlights the long hours he works, starting at 7.30am and often lasting long into the evening, adding up to well over 50 hours a week.

Practice manager Helen Harris told GPonline that the Facebook post had generated 'quite a response' from patients, and had been sent to local MPs.

'It's really about getting the public to be more aware of the real situation,' she said. 'When they are told things by politicians - particularly when the prime minister blames GPs for the state of A&E - although a lot of people will know that's not right, others will believe it.

'GPs are working really hard and it's good to know they are being heard. Winter pressure isn't winter pressure - it's all year round.'

Meanwhile, GPs have reported being blocked on Twitter by Bath MP Ben Howlett after challenging a post in which he said: 'Commissioners need to think of a process to encourage primary care to assist more than they currently are during winter months.' GPs called the MP's statement 'insulting' and offensive.

Read Dr Berrisford's Facebook post in full:

Being a 51-year-old full-time GP working 8 sessions per week, with 24 years of GP experience I can say that the problems currently being experienced in A&E are not due to lazy, greedy GPs not bothering to work, as the government seems to want to portray.

The problem goes back many years and is complex.

The majority of patients waiting for 12hrs on trolleys for beds are not relatively healthy patients that can be sorted out in a 10 minute appointment in primary care. Some are there because of complex medical problems that need hospital care, some because the community services to provide care to keep people safe in their homes, are just not available when they are needed and therefore hospital admission is the only option. The delays and operation cancellations are due to inpatient beds being blocked by patients who cannot be discharged to the community because again the work force to provide the physical care needed such as, washing, dressing, eating etc is completely over stretched and doesn’t have the capacity to take on more patients.

The advances in medicine over the last 25yrs means we are looking after a much more medically complex and fragile ageing population than ever before. There has also been a continual increase in the expectation of the general population of what the NHS can provide for them.

The concept of palliative care is now well established for patients with cancer. However some parts of the profession and the public find the concept that palliative care at home might be appropriate for someone reaching the end of their natural life without a prior diagnosis of a "terminal condition" a difficult concept to put into action. It is always easier to "be on the safe side" and admit the patient to hospital, even though that might not be in the best interests of the patient. This reluctance to adopt other care pathways rather than always going for the "maximum medical intervention pathway" is a strong driver for the increased demand for hospital resources (which cannot be provided in primary care).

As for GP’s - I get to the surgery at 07:30 in the morning, my first patient is at 08:00, I work through lunch and I usually leave the surgery at about 19:00 and then continue remotely from home on some evenings. My average working week is 53 hours a week (not including the extended hours Saturday morning surgeries ). During a typical day I may see up to 26 to 30 patients face to face in the surgery, deal with 10-20 patients on the telephone, do a ward round looking after a 63 bed severe dementia nursing home (seeing anything up to 15 to 20 patients there) as well as dealing with over 100 lab results, outpatient letters and referrals. Then on top of that with the help of a wonderful practice manager I have responsibility for employing staff and keeping the business side of the practice running . Oh, and I haven’t even begun to talk about the work I have to do for my annual personal development plan and appraisal test which must be achieved in order to keep practicing.

Despite working in the delightful city of Bath, recruitment of doctors and nurses is a nightmare. There have been very few and in many cases no applicants for a number of partnerships, GP salaried positions and practice nurse positions around the city.

But don’t GPs rake in the cash? No. The profits the practice has been making have been falling year on year. In 2016 I had to pay £8370 to the MDU for my insurance before I could see a single payment, that money as well as other fees such as locum insurance fees that I have to pay, all comes out of the "figure" that GPs earn. The idea that these lazy GPs are earning more than £100,000 per year is just government propaganda. I don’t earn anywhere near that figure and we are now reacing the point where salaried GPs are earning as much or more than GP partners, but without the responsibility of having to run a practice. Who in their right mind would become a partner in General Practice?

General practice is on it’s knees. Few junior doctors want to come into primary care and many of those currently in training want to go abroad to work. If the stats in your article are true, and they certainly feel like they are, then in the next 5 years we will lose 10,767 GP to be replaced by ??5000 new GPs. It takes 8 years to become a GP so I can’t see things getting much better any time soon.

Finally, there is no physical way that my practice which has been providing care for nearly 7000 patient for over 50 years can provide a fully staffed 7 day 12 hr per day service. When I originally started we did provide a 24hr 365 day per year service for our patients but then out of hours changed and the law changed so that all out of hours contacts had to go through a call handling service rather than directly to the GP. The introduction of the 111 service has been shown to be yet another government initiative like Labours "choice agenda" that has just served to increase expectation and demand for no clinical benefit, but that’s another story.

I’m sorry Mrs May, but please stop trying to blame the GPs yet again for the NHS problems. 90% of all patient contact in the NHS happens in primary care and 10% happens in secondary care, yet primary care only get about 10% of the resources.

Ever since I started medical school in 1986 my intention was to retire at 60yr of age. That goal looks increasingly unlikely as the pressure seems to be increasing relentlessly.

Charlie Berrisford GP

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