When General Practice no longer exists…

When General Practice no longer exists, and your child has Long Covid, will you take them to the offices of the Daily Mail instead?

Where do I begin? 

Tuesday, and the conclusion by House of Commons’ Committees that the Government’s pandemic response was one of ‘the most important public health failures the United Kingdom has ever experienced’; ministers viewing the crisis through ‘a veil of ignorance’. 

This week has seen the number of new cases of Covid in England approach 50,000 a day. Despite vaccinations, this heralds many thousands of people each day going on to suffer Long Covid and will lead to 200+ Covid deaths a day amongst the unvaccinated and those with other health conditions. The average person dying from Covid loses ten years of life, and their family ten years with their loved one. The Government refuses to mandate face masks in crowded public spaces – a simple public health measure – whilst continuing to sport their veil. 

To Thursday, and the Government’s announcement on how it will ‘support’ general practice and ‘improve access’ for patients: 

NHS England rightly acknowledges that ‘most practices provide accessible, high-quality care’. In 2021, 82% of England’s patients were satisfied with the type of appointment offered – up from 74% in 2019. Our patients, completing the same independent GP Patient Survey, by and large agreed. 

During the pandemic Spilsby Surgery adopted ‘total triage’ of requests for advice and care. We usually return telephone calls well within two hours and offer a face-to-face appointment if we agree it is preferrable to a telephone, online or video consultation. We prioritised primary care ahead of holding a contract to manage vaccination centres. As a result, we can offer same or next working day GP appointments despite rising contacts with primary care. No closed doors. No hiding. No shirking. We agree with NHSE that triage-first pathways offer long-term benefits to patients and practices. 

Before the pandemic, both Government and NHSE tried to browbeat general practices to adopt ‘remote’ consultation tools. In July 2020, the Secretary of State for Health opined that ‘all consultations should be tele-consultations unless there’s a compelling clinical reason not to’. GPs disagreed. Government has now performed a reverse ferret. 

We continue to blend face-to-face and remote appointments. We will be mindful of patient preferences. (Surveys in other practices indicate only 1 in 10 contacts want an appointment at the Surgery itself.) However, Spilsby Surgery’s waiting room is small and poorly ventilated. We need to ensure that clinically vulnerable patients – those most likely to need a face-to-face consultation – are as safe as possible and feel safe when visiting the practice. We also have an obligation to our staff to protect them, and ensure they are fit to care for you. Pandemics aside, demand for appointments in UK general practice exceeds supply – finite resources should be shared based on clinical needs, not on ‘wants’. 

The Government has trumpeted a Winter Access Fund for the period to March 2022, to support ‘same day’ primary care, ideally in patients’ own practices. And here the disconnect with reality begins. NHSE suggestions include 

• Funding more sessions from existing staff  Our GP partners work full-time hours compressed into three and a half days. For the rest of the week, they and our Associate GPs work as parents, educators, learners, and clinical leaders. 

• Making full use of the ‘digital locum pool framework’  No – me neither! Rural Lincolnshire has a paddling pool of locums. Clinicians unfamiliar with individual patients, their families and local resources are unlikely to prove effective at remote triage. 

• Employ … retired geriatricians who are unable to work as GPs because (a) they are not trained, skilled and registered GP specialists, and (b) they retired for the sake of their health and sanity. 

• Expanding … other services in … primary and community settings Historically this has meant giving resources to non-GP ‘hubs’ at Louth, Skegness and Boston. 

NHSE states it will be for ‘local systems’ to address ‘local issues’ to find local solutions. The Chief Executive Officer of NHS Lincolnshire CCG has recognised the outstanding work of Lincolnshire GP practices throughout the pandemic. He has promised to ensure that national guidance will be interpreted in a supportive manner locally. Spilsby Surgery will hold him to his word. NHSE expects a countywide ‘system’ plan within days. This risks a top-down approach and little coal-face consultation, and that a political preoccupation with face-to-face contact percentages reduces overall access to primary care. 

National guidance is heavy on ‘capacity’ – and a myopic preoccupation with doctor appointments in a multi-professional workforce, totally neglecting ‘patient safety’ and ‘quality’. Spilsby Surgery doesn’t necessarily need more patient appointments. Patients would benefit from more clinician and administrative hours to do the same volume of work; less plate-spinning and a reduced risk of breakages of patients and colleagues. 

The Winter Access Fund appears to offer very little practical help to this very busy semi-rural GP practice. This is a sticking plaster on the gaping wound of underinvestment in UK primary care. There are 1900 fewer whole-time qualified NHS GPs than in 2015, while the population has increased by 2 million. 

Friday brought the murder of David Amess MP, and the call by the House of Commons Speaker for a ‘kinder’ conversation between constituents and their MPs – as abuse, fuelling hatred, spilled over into violence. 

GPs whole-heartedly endorse this sentiment. Nationally, 1 in 5 doctors have been threatened in the last month. 2 in 3 have witnessed abuse or violence against other staff – the majority receptionists. The GP-bashing of recent weeks – fanned by the media, amplified by social media, and enabled by politicians including the Secretary of State for Health and Prime Minister – should also cease immediately before more NHS staff leave prematurely, are hurt, or someone else is killed.

Dr Stephen Savory

October 2021 .