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Independents' Day

Let's not pretend the NHS is open for business

Dr Renée Hoenderkamp 

The NHS is closed for normal business. Don’t let anyone tell you otherwise. Having written about the situation denying curative surgery to cancer patients (among other things) just three months ago, I find myself sitting and saying: ‘I told you so’. And I don’t relish in that statement.

I was frustrated back then and met cries of: ‘No, its not true, we’re doing cancer in the private sector’. And yes, a little bit of cancer was initially sorted in the private sector and now more routine stuff is being done.

But - and it’s a big but - what about other stuff? Some routine, some not so routine. What’s happening to that? Well, as a GP trying to get people seen, I can tell you… very little indeed. And today, just like every other day at the moment, it was sad and I left work really feeling for the patients to whom I said repeatedly: ‘I’m sorry but I can’t organise that at the moment’. I feel like an admin assistant telling the customer that the computer said no. I didn’t study medicine to be that person.

Today, as with so many days as a GP since Covid raised its ugly head, I am that person. And it’s so hard to explain why ‘routine’ for the NHS is so far from routine for the patient.

Imagine you were at home recovering from cancer - the surgery, the chemo, the diagnosis itself, and to make it just that much worse, you also have to stay away from all other humans because you’re just too vulnerable should they pass Covid to you. Then your hearing gradually vanishes, you know it’s wax because it’s happened many times before, but this time the effect is even more devastating because your hearing is the only thing allowing you access to your friends and family, to normality. But when you phone me to organise a simple sanity-saving procedure, I say sorry (well, I shout it): no, not at the moment. Imagine being so distressed by this news that you call 111 for help, and they tell you to speak to your GP.

Patient by patient, they’re critical for some

Imagine you have dementia. That your GP knows you well and has worked to get you seen and treated at the memory clinic, but she has recognised that things seem to be worsening. She refers you back to the memory clinic. They do a telephone appointment and agree with your GP and write to them. They say in the faceless letter that they’ve discharged you from services as point one and for point two, asks your battle-weary GP to refer back for face-to-face assessment and commencement of a new drug that may help things slow a little, when services reopen. Not only is this a wicked waste of yours and your GP’s time, but the clinic have no idea of when that might be, and they tell your GP that they can’t start the medication.

Imagine you have slowly deteriorating hearing, making everything difficult, but not impossible. But because you’re reading the papers, you’re aware enough of the tsunami of referrals to come to GPs, that you think you’ll get in early because actually, while being almost deaf is not impossible for you personally to deal with, it’s really hard. So you want to ask to ask your GP if they can do the referral for a hearing test today, so you’re at least in the pile when things get going again. Imagine you’re that totally reasonable patient downplaying their symptoms.

The list is endless. There are patients desperate for scans or X-rays which aren’t ‘urgent’ if we’re talking red flag urgent, but are important in terms of management and giving us a clue as to what we’re dealing with. They are of course urgent for the patient. The fertility referrals which take eons anyway, but at the moment I can’t even get a semen sample done, which is needed for any referral. The ring pessary changes which are well overdue and causing distress, but are deemed non-urgent. Who is deciding that these things aren’t important? I get that they sound trivial on paper, but in context, patient by patient, they’re critical for some.

And so I sit and apologise for the computer saying no. It’s sad and it’s frustrating, but above all, it’s wrong. I hear stories of staff sitting in clinics with no patients. We’re sending texts telling people that they must come forward if they have an issue. The media is selling a tale of ‘The NHS is open, please don’t delay if you need us’. But it isn’t, and someone who can change things needs to know… the NHS is closed for routine stuff and I’m, as always, the merchant of doom at the gate (or true frontline).

Dr Renée Hoenderkamp is a GP in North London

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Readers' comments (11)

  • Poignant examples. The NHS is open to procurement and third party sector back-handers and corruption. Everyone's passing the you - you're left with a glimmer of responsibility and a want to help. Dishonesty and disintegration. A murky ocean of obstacles, a broken oar and leaking boat.

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  • Yes very true. This could be what ‘integrated care’ means after all...

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  • I agree 100%. Sad and frustrating state of affairs.
    I suspect that giving almost everyone an unexpected break in their NHS workload for nearly 4 months (yes, us too) is not something anyone wants to rush back from. I reckon 50/50 split exists between clinicians on "won't" versus "genuinely can't" help.
    An Xray receptionist told me 2w ago that although their scanner hadn't been used all week, "London" says no non urgent footfall until 1st July and no exceptions. Not negotiable apparently. If you are cynical (Moi?) this was another few weeks of reduced expenditure. Obviously the NHS would be able to recognise a second wave and this should be up to 2 weeks in arriving....plenty of time to do some "boring, normal work" in between.

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  • The government has failed in its goal pf protecting the NHS

    Worth remembering also that "going private" is not currently a viable option with the private hospitals seeing their seres to NHS and private clinics cancelled.

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  • In my area the health of cardiology patients is being used as a pawn / bargaining chip in a CCG bickering battle over who pays for some aspects of the local covid-19 response 1 Cynical in the extreme.

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  • I would collect together these examples and forward them to your MP and the newspapers rather than posting here. More powerful.
    I also agree that the less activity the less cost to government who, currently, must have echoing coffers. Thus, it is in their interest to delay ‘non urgent’ stuff as long as they can. Infact this might well be a fast track to their ultimate goal of privatisation??

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  • I completely agree. From a patient perspective there is virtually no NHS service available . My son can’t get a doctor to see him with his painful tender new lump on his testicle (he had a tortion as a baby and only has one), The lady who paints my house has a newborn and can’t get anyone to see it despite it not opening its bowels for a day and screaming non-stop. My other son had otitis externa and could it get a GP appointment. I had a UTI last week and could not an appointment. I couldn’t even get through on the phone. Luckily I can still get hold of antibiotics, but it would’ve been nice to get a sensitivity test. I would also like to talk to someone about why I’ve had eight urine infections this year and very slow flow following my TVT.
    As a retired GP I completely sympathise with the patients and feel quite abandoned.

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  • Lovely to see “escaped gp” putting in the boot! You are lucky you have escaped.

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  • This article has a particular poignancy for me and all of the examples are ones that I recognise in my day-to-day practice. Patients keep on asking me every single day how you coping with coronavirus. My simple answer is, it is not the coronavirus itself that is causing the problems, it is rather the fact that significant proportions of the NHS have shut down. NHS primary care adapted to the new working practices within about a week of the lockdown. We were doing things like video consultations and new working practices. The response from our partners in secondary care has effectively been to divest themselves of significant proportions of their clinic workloads looking after some very unwell people whom have naturally come back to primary care. There are certain specialities that seem to have disappeared off the face of the earth for no rational clinical reason. I have to admit in the interest of patient's and out of clinical courtesy I have been doing a lot of clinical activity that really should be long wholly squarely within secondary care out of goodwill. Secondary care have done nothing to develop any mechanism to look after their patients remotely except just to pass things back to the GP. What is even more worrying, is that now in "education sessions "long per sessions of consultants are now telling us what "the new normal "for their outpatients will be. Sadly, what was done in goodwill appears to be their version of the future. I do not think that certain sections of the NHS deserve a Clap at all, they deserve a boo.

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  • Renee I can sympathise if this is your experience but it is not mine as a full time GP in South West London area. I also feared and still fear the xs cost of the over brutal NHS lockdown of services on overall morbidity and mortality and some services are taking longer to see patients and routine ops delayed, but in general we have no issue with getting routine x-rays, scans, discussions with secondary care colleagues, and GP services fully open and seeing patients F2F as needed same day as usual... I don't think Secondary care colleagues are trying to clear their books of patients and are hard working and trying to find effective ways to manage patients.
    I wonder if it is your CCG that is struggling and thus restricting access ? CCGs need to be very proactive and strong on getting services up and running effectively.

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