Lockdown is easing, but as everyone lets out a cautious sigh of relief that normality may be around the corner, GPs are dealing with a tidal wave of work which shows no signs of abating.
When the pandemic descended last March, NHS England mandated the move to ‘total triage’ in primary care to protect patients and staff from COVID-19. We transformed our services overnight, moving our 1m consultations a day to remote telephone, video and online consultations, while localities shared staff and resources to set up hot hubs to see anyone with a clinical need.
Busier than ever
Data from NHS Digital showed, contrary to the reports of being ‘closed’, general practice was busier than ever. Not only busier, but dealing with more complexity and carrying the increased risks of remote consulting.
Every part of the health service has felt the strain of the pandemic. Secondary care deployed staff and cancelled routine work to funnel the majority of their resources into critical COVID patients. General practice held the fort for everything else (before even mentioning the millions of people we vaccinated). Waiting lists have spiraled and we in general practice are feeling the impact.
Patients waiting longer for operations need more GP appointments to manage their unresolved symptoms. We titrate up pain medications in one consultation, only to then treat the side-effects of those medicines the next. Those waiting for investigations have longer to worry about what might be wrong, or to re-present with deteriorating symptoms.
Meanwhile, patients who have stayed away throughout the second wave are starting to reappear. Many have been sitting on worrying symptoms for far longer than usual. People are sicker, there is more pathology, and even when the problem itself is straightforward, health anxiety is rife.
The mental health fall-out from the pandemic is only just beginning. Bereavements, job losses, financial strain, families imploding under the pressure of lockdown, people daunted at the prospect of rebuilding everything from scratch in a world where everything is more difficult than it used to be.
The impact of remote access
Remote access has made us paradoxically both more and less accessible. Online consultation systems allow busy people, who would never take time out of their day to come to the surgery, to contact us more often, about problems they previously would have ignored or dealt with themselves.
E-consults submitted when anxiety strikes at 3am about a self-limiting symptom, seem essential at the time, but more often than not, have resolved when the GP makes contact within the 48-hour timescale. The time spent reading the notes, excluding red flags, and then often dealing with a list of ‘while I’ve got you doctor…’ means GPs are working harder than ever 'not seeing’ people, leaving the hard of hearing and less technologically able struggling to access care.
Healthwatch’s recent report confirmed that patients do feel they are unable to access a GP, with 75% of respondents reporting negative experiences. Over a year into this crisis, there remains a widespread belief, perpetuated by some parts of the media that GPs are closed. Changing this mindset may prove impossible.
Colleagues report conversations with patients they are in the process of seeing face to face, in their surgery who ask mid examination ‘When are you going to re-open doctor?’. People who have had multiple remote contacts with resolution of their problem also remain dissatisfied - clearly there is a therapeutic value of looking their doctor in the eye.
What is the solution?
The Doctors’ Association UK has asked NHS leaders to take note and urgently review this crisis in primary care – which is a reflection of the state of the NHS as a whole. But what is the solution?
Throwing more money at primary care is only going to work if we have the right people in place to enable it to function. The NHS continues to haemorrhage experienced staff – due to burnout, retirement, alternate careers and more accommodating health systems overseas.
Ivy Grove Surgery in Derbyshire spoke out last week, with a 16-page open letter to patients outlining why demand is so high right now. Many found their honesty unpalatable and patient-blaming but their words undeniably resonated with frontline GPs, and the points they raised need to be brought to the table when discussing how we improve this situation.
Perhaps the answer lies in our individuality as GPs. Access arrangements to general practice have never been more uniform, nor more uniformly unsatisfactory to both patients and staff. What works for one patient population is completely unworkable for another.
Give us back the freedom to limit the e-access and decide what will work for our own unique mix of patients. The risk-benefit balance of a walk in and wait surgery will look very different in a rural community to how it would look in the centre of London. We need to be able to make those choices based on our expert knowledge of our communities, and it is time for us to start putting that expertise back into action.