‘I think it’s going to be a very difficult time in general practice this winter without having additional support in place’, says Nottingham GP Dr Shan Hussain, ‘I do fear for the future.’
Dr Hussain, who has worked in the profession for 20 years, says he and colleagues have been working ‘flat out’ for a number of months now, with demand for appointments ‘skyrocketing’ during what he described as the busiest approach to a winter he’s ever seen.
Tasked with carrying out a COVID-19 booster campaign, running the UK’s largest annual flu campaign and dealing with a backlog of care - in addition to performing routine work - general practice staff are facing a monumental challenge.
GPs have dug deep to ensure patients are treated safely. But Dr Hussain says a barrage of negative articles appearing in the national media over the last few weeks is demoralising the workforce and threatening resilience.
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> Face-to-face appointments on demand 'unachievable', warns RCGP chair
‘We're concerned about the reporting that certain sections of the press have done in the last few weeks - every day there's something else that they want to blame us for,' he says. ‘Speaking to friends and colleagues across the country, the mood is very quickly moving from being defensive to angry.
‘It's reached the point where we are just fed up with the spread of misinformation in the media. I'm sick to the back teeth of the press saying we're closed, or that we're not working hard enough, or that we're not actually seeing patients face-to-face. None of that is true.
‘I’ve had experiences where a patient has been sitting right in front of me in my consulting room, asking when we are going to open again. I've met nurses at vaccination centres who have asked when GP practices are opening again - and I just don't know where this is coming from.’
National media campaigns have called for more face-to-face access to GPs. However, official statistics published show that general practice delivered more than 15m face-to-face appointments in June this year - along with more than 10m phone appointments and millions more in-person COVID-19 jab visits. Overall, the figures show general practice in England delivered 31% more appointments in June this year than in June 2019.
Face-to-face appointments
Data show that, even excluding COVID-19 vaccine appointments, total appointments in general practice in June 2021 were just over 13% up on the same month in 2019, before the pandemic - with around 56% of these appointments being delivered face-to-face.
‘We've never been closed, we've always been open, we've just been instructed to operate differently, and that's what we are trying to do to the best of our ability with the limited resources we have,’ Dr Hussain adds.
Consistent smearing of GPs’ work in the media is now contributing to very real workforce consequences for general practice, according to the Nottingham GP, who says he has spoken to colleagues looking to leave because of the current pressures.
‘I know many doctors who are sorting out their exit plans at the moment, and determining what they want to do, which really is heartbreaking to hear - especially as many feel that they're being forced out or bullied out of the profession in light of lots of things that people are saying, many of which are untrue,’ he says.
Attacks on clinicians
Last week four members of staff at a GP surgery in Openshaw, Manchester were injured during a violent attack from a member of the public, which resulted in one GP suffering a ‘skull fracture’. In a statement, the BMA said it was ‘truly horrified’ by the incident - highlighting it came off the back of ‘escalating anti-GP sentiment’ being pushed by some media outlets.
A survey by the union in August found that more than half of GPs had personally experienced verbal abuse in the past month, while over two thirds have witnessed violence or abuse against colleagues.
Salaried GP Dr Neena Jha says she is concerned about her safety at work after the recent attack. ‘It's quite terrifying,' she says. ‘I work in general practice and in A&E, and I never fear for my safety when I'm in A&E because I've got people around me - there's security there and I've got backup.
‘Whereas general practice is quite different depending on the practice - you can be quite vulnerable. There's a lot of lone working involved in some practices, so quite often after a certain time on certain days I'm alone, I might be the only one in the practice along with one or two receptionists.’
Patient safety
Misinformation about the way GPs are operating is not only bad for morale, according to the salaried GP, but also potentially dangerous for patients. ‘I remember a year ago seeing headlines that GPs were closed and around that time a patient approached me in a supermarket with really significant symptoms.
‘She apologised [for approaching] and said that she would never do this usually, but asked me when the surgery was opening up because she had this symptom. What consequences are the stories having for patients who genuinely believe those headlines, and are holding on to symptoms waiting for GP practices to "open again"?'
She adds: ‘There’s a very targeted campaign at the moment specifically directed at general practitioners, and we really don’t want the public to assume we don’t care because nothing could be further from the truth.’
Surrey GP Dr Dave Triska says that misinformation has increased the amount of criticism he and his team face, admitting that they are having to deal with at least one complaint each day. He warns this is eating into time with patients.
Time with patients
He says: ‘I think the biggest change has been around initial attitude. On the whole our patients have been pretty good, but there's certainly been a proportion where the opening of any consultation is with flat out aggression - asking us why we aren't seeing people, all of the stuff that's been in the media.
‘But I have a very good touch point for my practice because we haven't changed any of our clinical practice for three years, we haven't changed the way we've delivered anything, so it's just ludicrous for people to be saying that to us because we haven't made any difference to our service provision at all because we were already working like this.
‘It’s getting a bit wearisome because we’re actually delivering, and delivering well, but the time it is taking us to deal with all of this stuff is actually really challenging and it’s taking away from clinical time with patients.’
Dr Triska says it’s unfair for GP teams to get the blame for issues that have been created by years of primary care underfunding. But he suggests that workloads could be halved without spending a pound.
QOF suspension
‘Why are we not undoing the administrative burden on things like QOF? Why are we having to have people chase around for scraps of funding when overnight you could halve GP workloads with no extra funding required - and as a crisis measure that’s really important.
‘We probably can’t do that much about clinical challenges at the moment because there are no people out there - there is no one coming over the hill - everyone is super busy. But you could stop all of the nonsense that we have to chase day after day after day, filling in endless reports for information that we already have. Why no one is drawing up a crisis plan now is beyond me.’
This week the BMA GP committee demanded an emergency meeting with the health secretary to discuss its concerns about an ‘unprecedented rise’ in workload and to explore what support can be offered to GP practices as they enter a busy autumn-winter period. It has also recently called for an 'immediate suspension' of QOF with income protection to allow GPs to focus on rolling out the COVID-19 booster campaign.
