Viewpoint: GPs will be there for patients this winter, but at what cost?

Rising to new challenges is in GPs' DNA and the profession has not let patients down through the COVID-19 pandemic, says Professor Dame Clare Gerada. But intense pressure on GPs is exacting a heavy toll on their mental health.

Professor Dame Clare Gerada
Professor Dame Clare Gerada

As COVID-19 infections rise again, GPs are winding up for an even busier winter than normal, having only just left behind an exhausting spring and summer.

And despite newspaper headlines general practice has been open and working throughout this pandemic. It has never shut. In fact, it is busier than ever, dealing with our patients' concerns, supporting them during this crisis and managing business as usual.

We have not let our patients down. But we would expect nothing less from our profession, as GPs have always risen to challenges, whatever is presented to us. Since the dawn of the NHS we have provided safe, accessible and patient-centred care.

Adapting to COVID-19

In recent months we’ve had to adapt to new ways of working. In the space of one week we moved almost all of our 1m consultations per day online, improved patient flows and skill mix and allowed staff to work at the top of their licence – using their skills more effectively.

COVID-19 has changed how we organise ourselves, within and across practices. Practices have merged with others, with some becoming hot sites seeing only COVID or acute infections, with others remaining open for all other patients.

This has necessitated us sharing staff, co-locating others from different practices onto a single site, pooling expertise and bringing in new practitioners to help us. And we have done this while continuing to keep ‘the show on the road’.

Leading the NHS Practitioner Health service - a confidential service for doctors with mental illness - I am only too aware of the toll the pandemic has had on the mental health of doctors, which was a concern even before this plague began.

Mental health

While correlation doesn’t equate to causation, nevertheless the impact of COVID must surely be contributing to the increase in numbers of doctors presenting for help compared to pre-pandemic levels - from around 60 per week to now regularly over 100.

The rise in numbers is across all specialities, though proportionally GPs now make up a bigger percentage of the overall case load – up from around 50% to nearly 60% of all new presentations.

It is not hard to think why GPs might be presenting in increasing numbers. In the first instance, GPs are victims of their own success. We rise to challenges thrown at us - as we have done with this pandemic - and we do this quietly, without film crews recording our heroic endeavours.

Add to this that for years, general practitioners have been the victims of unrealistic demands and have to carry a huge weight of expectation laid on us by patients, politicians and policymakers who expect far too much from us.

GP funding

That somehow, we can magically make good the problems of chronic underfunding. That we can sprinkle fairy dust and make good the failures of the wider NHS and social care. That we alone can solve the fault lines in the welfare state.

The response of many of us to impossible challenges like these, is to do what we have been trained to do – push ourselves even harder, make more sacrifices, risking burnout and mental illness along the way. No wonder that many of our profession feel so exhausted.

While masks and gowns might defend us in part from the physical contagion of the virus they do nothing to protect us from its psychological effects or from the collateral damage that the negative press about us ‘being shut’ is causing. There is no easy solution. The need to find a scapegoat for the problems our patients are facing is inevitable and general practitioners are easy prey.

Our patients are frightened and turn to us to reduce this fear. I believe patients are angry with us not because we cannot see as many of them face-to-face - many probably would be reluctant to accept this even if offered - but because, perhaps for the first time for many, they know that we cannot make their situation better.

Neither our medicines nor our words can protect them from their greatest fear, which is the fear of death. However, even given our problems the relationship between us and our patients remains strong and built on trust, support and safety.

Those who have needed a GP in the first wave have been able to access care and will continue to be able to as we enter this second phase. GPs will be there for their patients, and Practitioner Health will be there for GPs, to offer support and care when they need it most. Save our details as we enter the darkest months, pass them on to your colleagues – we are here for GPs across England and just a call or email away.

Dame Clare Gerada is chair of Doctors in Distress and Medical Director of NHS Practitioner Health. Her new book Beneath the White Coat: Doctors, their minds and mental health is published by Routledge this October at £22.99 and can be purchased here. All royalties will be donated to Doctors in Distress.

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