I had a recent consultation as a patient and as I was about to leave the doctor popped the question – ‘what do you do for a living?’ To which I answered, ‘I am a doctor.’ ‘What kind?’ ‘GP,’ I said, and whoosh - out came the familiar theme: ‘I hope you guys have started seeing patients face to face’.
All the treatment I had been privy to as a patient for 30 minutes (during which time as a GP I would have been expected to see three patients and still get interrupted by an urgent call from secondary care requesting background medical information, or an up-to-date medication list for their patient) suddenly vanished and I was faced with torrents of questions.
I did try to enlighten my hospital colleague and his team that I and thousands of GPs did not stop seeing patients face-to-face during the pandemic started - even at its peak.
I managed a smile said thank you for the care I’d received, but walked away feeling dejected. Not that I haven’t heard this before. I have heard it often, the most recent being a couple of days before this in a train station. There is no escaping it. Everyone seems to have an opinion on the face-to-face issue.
I do understand that some people may not have had positive experiences, but I believe a larger proportion of people have had great experiences but are just not sharing this. The press has chosen to broadcast only the negatives, clouding out the positives and social media seems to amplify this.
Support for NHS has turned to anger
If you think back to the start of the pandemic the NHS – including GPs – was heralded with claps, appreciation and support. Yet now if you say you are a GP it is met with near aggression and disparaging comments. The claps have turned to slaps!
What then has changed? The novelty has certainly worn off. I decided to look beyond the feeling of being attacked to try to understand the situation. The first issue I can see is the long waiting times patients endure before being seen by the specialist.
The pandemic has created a backlog, and GPs usually bear the brunt of these frustrations as we are the first point of call and are accessible for queries. GPs are deemed the gatekeepers and gateway for accessing further care - both secondary and tertiary care, so we are at the forefront of this.
Reception staff at GP practices have been heavily attacked. They have been seen by patients as a stumbling block to allowing them to see their doctor. The truth is we never stopped seeing patients face to face. Most surgeries adopted safer and more efficient methods because of COVID-19, just like every other organisation in the UK did.
Patients who need to be seen face-to-face after triage (telephone and electronic consultations) are asked to come to the surgery in person. In my own practice patients actually have a choice to be seen face-to-face based on want and preference rather than need. They are often asked at the point of calling in how they want to be consulted, we recognise the elderly patients in particular enjoy seeing their doctor face to face, even for a chat around their wellbeing.
But, as most of us in general practice now know, some things can expediently be achieved over the telephone or through electronic consultations. Some patients opt for these methods because it is more convenient and saves them time and effort.
In most situations, when these alternative means of consultation are deployed and the clinician feels it is unsafe to continue using this method, they will switches to face-to-face to address a concern that has been picked up.
The public needs to be made more aware and educated about these deeper details surrounding decisions on different modes of consultation and how primary care has evolved in order to cope with, not only the pandemic, but a chronic shortage of GPs.
Of course the elephant in the room is NHS funding, which is actually the bigger and major issue in this. This drives how things are done and determines which services survive and which function optimally.
Workload in general practice has exploded since the pandemic and GPs are simply overwhelmed and struggling to cope with the sheer volume of patients needing to be seen. This is filtering back to patients feeling that GPs don’t want to see them face-to-face, but the issue is that there is not just enough capacity to see everyone. There are not enough GPs to go round.
GPs are leaving the profession in droves due to unsustainable pressures of working long hours, without breaks, in a system that is short of funding. We need more GPs. And while the NHS is trying to employ lots of other professionals to help do some of this work, other important things that require GPs, such as focusing on patients with more complex health needs, will still require us to have more GPs.
GPs are relocating to work in countries where they are better remunerated and also have better working experiences, or are simply leaving the profession to have a better work/life balance.
I am giving my whole best to this job and it is time we start looking at where the problems of access really lie and stop attacking us, the messengers. We need to address the real issues, which are educating the public around health needs versus wants, government and NHS funding, working morale, the current deficiencies of GPs and awareness around accessing other qualified staff.
A shout out to all my fellow GPs – keep your morale up, focus on any of the positive feedback you are getting for your hard work and dedication. The truth always prevails, and it will in this case too.
- Dr Oginni is a GP partner in south east London