Half of GPs say patients harmed by delays to care during COVID-19 pandemic

Nearly half of GPs say patients on their list have come to harm because of delays to care during the COVID-19 pandemic, with some reporting patients have died while waiting for treatment, a GPonline poll has found.

(Photo: Ollie Millington /Getty Images)
(Photo: Ollie Millington /Getty Images)

The survey of 420 GPs found that 45% knew of a patient who had come to harm because of delays to routine care caused by the pandemic - with additional waits for diagnostics, urgent cancer referrals, cancer treatment, surgery and outpatient appointments highlighted by GPs.

GPs also expressed concern that some patients had delayed seeking help from their GP or A&E services because they were afraid of contracting COVID-19, resulting in late diagnoses which could impact on the success of treatment.

One GP responding to the poll said that a patient had died while waiting for heart bypass surgery to be rearranged after it was cancelled because of the pandemic.

Delays to care

Another GP reported that a patient had died while waiting for a delayed investigation for weight loss and dysphagia and a further respondent said they had 'several examples of what could realistically be deaths due to delayed or cancelled care'.

The poll also found that 93% of GPs were worried that patients could come to harm as a result of delays to care because of the pandemic. Several warned that the NHS was now so overstretched with huge waiting lists that more patients were waiting longer and the situation would only get worse if COVID-19 cases continued to rise.

GPs also raised concern that the move to remote consultations via phone and video, by both GPs and hospital consultants, ran the risk of significant conditions being missed or diagnosed late. Not seeing a doctor face-to-face had also led to increased levels of anxiety among patients, some added.

Among those who said they were aware of patients coming to harm, delays in referrals for diagnostics and cancer treatment, surgery cancellation and a struggle to access outpatient appointments were among the most common reasons cited by GPs.

Others also highlighted referrals for urgent mental health issues being refused and patients being discharged from hospital 'too early' or without any communication with their GP or community support services.

Patients harmed

One GP said they had a patient who was diagnosed with cancer following a CT scan in February. '[They] did not have follow-up imaging until July. Now told that it has metastasised and is no longer treatable,' the GP said.

Another added: 'Delayed two-week-wait referrals from March are understandable but nevertheless have caused harm. [There are] delayed treatment paths for cancer patients and non-cancer patients needing a consultant specialist opinion. I have had to fight to get patients seen and investigated at all. Thresholds for investigations have been wantonly changed to be higher, meaning more people put at risk and left in general practice to be managed with concerning symptoms – at normal times they would be seen and treated in secondary care.'

'We cannot get any outpatient appointments,' another said. 'Choose and Book is saying more than 200 days' wait. It is hard to access advice and guidance from some specialities. Patients are being lost to follow up, they are told they will be seen [by the hospital] and then never contacted.'

Meanwhile, delayed or cancelled operations were leaving some patients in 'considerable pain', GPs said. One said: 'I have patients with operable cancers that have not been operated on due to COVID.'

Another added: 'Delays in outpatient appointments for pain injections and other procedures is having a significant impact of patients' physical and mental wellbeing.'

Patients staying away

Patients' fears about contacting their doctor or attending hospital during the pandemic were also resulting in delayed diagnoses and potentially affecting outcomes, GPs warned.

Several said that they were increasingly seeing patients who would have presented months ago, suggesting there is still a significant number of people who have yet to see a doctor about their health concerns because of the pandemic.

One GP said: 'Lots of patients are now stating they have had symptoms "since lockdown started", so they are presenting now rather than four to six months ago.'

Another added: 'My heart sinks when I hear: "It started about the time of lockdown". The number of two-week-wait referrals in the patients I'm now seeing is high.'

Statistics from NHS England show that during the first peak of the pandemic in April, the number of urgent cancer referrals from GPs was a staggering 60% lower than the same period in 2019. GPs made 79,573 referrals in April 2019 compared with 199,217 in April 2020.

The number of two-week-wait referrals from GPs has been increasing since then. However the latest statistics for August 2020 show that they are still 15% down on the figures for August last year – there were 30,657 less referrals in August 2020 than August 2019.

Cancer treatment

The pandemic has also hit cancer treatment. A poll of 1,900 cancer patients by Cancer Research UK in May found that one in three said that their treatment had been impacted by the COVID-19 pandemic. The charity estimated that between lockdown and the end of July around 38,000 fewer treatments had taken place than it would normally expect.

An NHS England spokesperson said: 'Family doctors are the first port of call for most patients accessing NHS treatment and while this is a small snapshot survey, it is an important reminder of the need for convenient and safe phone, face-to-face and video appointments so patients continue to get timely access to tests and treatment.

'At the height of the first COVID peak, some people chose to postpone care, but since then hospital admissions have now rebounded, routine operations have more than doubled and cancer treatments are now taking place at well above usual levels, and the NHS message to the public is clear – do not delay, help us help you by coming forward so you can get the care you need.'

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