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GP pressures: ‘Everyone is exhausted and we don’t have a lot more to give’

covid vaccinations in Wales

GPs facing tough Christmas amid the drive to boost the nation’s immunity to Omicron. Rachel Carter reports

The Prime Minister’s announcement that all adults should be offered a Covid booster jab before the end of the year came as a surprise to GPs – who not for the first time this year found out about key changes to their workload at the same time as the general public.

And with staff shortages, the usual winter pressures, plus the ongoing additional workload of managing patients who can’t currently be seen in secondary care, this arguably couldn’t have come at a worse time for the profession.

‘In one sense it is an absolutely astonishing thing to do to make that announcement having made no effort to talk to people delivering the actual vaccination,’ says Richmond GP Dr Nick Grundy.

‘But on the flipside, it has been the same pattern all the way through: Government by media and it’s utterly stupid. So, in that sense, it was entirely unsurprising and disappointingly so.’

As has been the case with many of these announcement this year, the details also trickle down after the fact – meaning GPs and their staff arrived at work the next morning to an influx of requests to book a booster jab – before they even knew when they would get extra vaccine stock.

Dr Grundy says local commissioners were ‘just as frustrated as we were’ when there was still ‘no definite confirmation’ of additional vaccination deliveries last Tuesday afternoon (14 December).

‘The question is do you put a clinic up and have to risk cancelling it, or do you not put a clinic up and by the time you do people have gone elsewhere – it’s tricky,’ he says.

‘Uncertainty for staff’

The announcement also came with the instruction that GPs should prioritise booster vaccinations over ‘routine care’.

At an NHS England webinar last week (13 December), NHSE medical director for primary care Dr Nikki Kanani said it was ‘really difficult’ to give practices a list of things that they ‘need to stop’ as it would vary by practice and patient need. She added that the BMA and RCGP would be providing some additional guidance on prioritisation ‘shortly’ – but this has not been published yet.

Dr Hussain Gandhi, a GP partner in Nottingham, says reorganising work in general practice to promote the vaccination scheme is obviously important ‘but at the same time we have been told to stop doing what is considered routine or non-urgent – with no guidance on what that might be.’

‘Trying to stop planning to do work in the next two weeks is difficult because we’re already fully booked out for the next two weeks. It’s clearly causing a lot of uncertainty for staff, and for patients, in terms of what to do,’ he says.

Dr Irfan Malik, also a GP partner in Nottingham, says that the request to reduce routine working will also be difficult because ‘many of the cases are on-the-day urgent at the moment – and if you do delay routine stuff then it can turn into more urgent cases’.

‘[The pressure] has been intense for a number of months, we are facing problems with the NHS backlog in hospitals as well, so it has been very, very busy – and nearly two years into this pandemic, the workforce is very tired. Receptionists, the nursing team, and doctors are all struggling,’ he adds.

‘So, this announcement that we have to step up to help in the vaccination programme in the next two weeks didn’t help the overall situation.’

Face-to-face demands

The instruction to prioritise boosters has also come just two months after the Government and NHS England demanded that GPs deliver more face-to-face appointments, with those deemed to be the ‘worst-performing’ on access told they would get no extra money this winter.  

Earlier this month, DHSC told Pulse that the Government’s plan B Covid measures do not change its expectations on GPs to increase face-to-face access in line with the Winter Access Fund.

But the day after the booster announcement, health secretary Sajid Javid told Radio 4 that the ‘most important face-to-face GP appointment patients will have in the next few weeks is getting jabbed’. 

Understandably GPs are in disbelief: ‘You can’t brief the media over the summer about how GPs are shut and it’s awful and you should have the right to demand a face-to-face appointment and then flip-flop at this point to say “yes, it’s spreading widely everyone should stay ay home and don’t worry we will get the boosters sorted out and aren’t GPs wonderful”,’ says Dr Grundy.

‘You can’t flip-flop like that and expect people to take you seriously. It does reach a point where you think we’ll ignore what the circus is saying and do what we think is right.’

It also leaves practices in an impossible position. As Dr Suman Thullimalli, Doncaster GP and clinical director of Doncaster East PCN explains, surgeries have opened up and ‘many of them were offering face-to-face anyway’ so it is ‘not practical’ to suddenly tell them to prioritise emergencies only.

‘It’s not easy to open up and close as we’d like…more practices have opened up already and booked up clinics and things and to ring and cancel the appointments and redo duty rotas is very difficult.

‘And there is no workforce to do that – all the staff are tired, or off sick and on leave…so these two weeks they will struggle more than usual because it is not possible to cancel.’

Speaking on the pressures in general practice more widely, Dr Thullimalli adds that he is hearing of many people ‘thinking about giving back the contracts if this continues’.

‘I think they are worn out – that is the feeling everybody is having, because there is no credibility, no gratefulness, no recognition, and they keep on giving more and more and more work.

‘And it is a bit of a battle with the Government, NHS England, local commissioners, with patients, with everybody – they are using general practice as tissue paper, that is the feeling out there.’

Omicron surge

Sadly, it isn’t likely to get easier any time soon. At last Wednesday’s Covid briefing (15 December) CMO Professor Chris Whitty warned that the expected ‘sharp peak’ in Covid cases caused by the current wave of the Omicron variant would lead to staff shortages in the NHS. ‘There will be significant problems of people actually providing staff, to man and to generally be able to look after any part of the health and social care system,’ he said. On Thursday, a record 88,376 new cases were reported in the UK.

Surrey GP Dave Triska says he feels ‘furious’ that after ‘months and months of being ritually denigrated in the media’ GPs are ‘suddenly being patted on the head and told we need to fix it all’ – and at a time when they are dealing with ‘a massive respiratory influx and illnesses that can’t wait’.

‘It feels like we’re back in March last year, having red and green zones for the practice again, protecting clinically vulnerable staff…it really feels like a huge step backwards,’ he adds.

‘It’s very disappointing and I think the vibe from clinicians seems to be very similar – of just waiting for it all to hit and just knowing that there’s going to be impossible things to do for an unspecified amount of time – possibly months and months and months. But the difference this time around is everyone is exhausted, and we don’t have a lot more to give.’


John Glasspool 20 December, 2021 4:45 pm

Look folks: no one is going to care how much pressure GPs are under unless and until the system collapses. I realise it’s pretty broken now; an ill friend had to wait 10 hours for a call back from 111 recently. It needs a domino effect in some big cities, where all the practices fail at once, more or less.

You have to remember the tories HATE the NHS. It is anathema to them. As Nye Bevan said, The NHS is “Pure Socialism”. And indeed, that is true. Something provided for all, by all, for use when needed. (OK- sometimes just when “wanted”, but you know what I mean.)

Doc Getmeout 20 December, 2021 4:59 pm

In this article, the words says it all and that pop out:

staff shortages, winter pressures, workload, exhausted, tired, frustrated, uncertainty, not easy, no work force, no gratefulness, no recognition, a battle, etc

The language sums it up.

Patrufini Duffy 20 December, 2021 5:15 pm

I bear little sympathy moving into 2022, for the good-doers and the “let me constantly follow you up for free” altruists, who want to sign up to everything dangled, who want to be an “everything specialist”, but know little of themselves, more about hugging trees, and who take the money, out of fear and sheepish-ness, then complain that they’re busy. Stop ticking their boxes.

The Prime Minister 20 December, 2021 8:00 pm


Northern Trainer 20 December, 2021 9:53 pm

No one minds rolling sleeves up to support an organised and insightful response. But when it is so chaotic and incompetent at all levels above us and we are not listened to or invested in then the impact is inevitable. There is no plan.
Stop doing fit notes for month and download a mindfulness app. Don’t see people but see more and call more. Have a third of backfill for non-existent locums. Let’s make the most expensive understaffed section of our teams do the least taxing work. Observe for 15 – oh actually don’t bother. There is no plan.
I naively don’t care about Tory agendas and I am powerless to stop the millions about to wasted in ICS & relabelled CCG salaries. What I do care about is my team and our patients – and I am now getting truly worried. There is no plan.

Kevlar Cardie 21 December, 2021 10:41 am

Ditching my martyr complex sometime ago proved to be highly beneficial to my mental health.
I come in to work, work damn hard and then go home.
I didn’t f**** this system up so you’ll understand if I don’t lose too much sleep about it.
Stop the self flagellation: like all forms of ostentatiousness its a little tedious.
When one understands at a deep, real level that we are led by sociopaths then everything that they do makes sense and one can plan accordingly.

Finola ONeill 21 December, 2021 5:40 pm

Yes. We must stop the self flagellation. Ignore the noise. And renegotiate the bloody contract.
Ditch or restrict the PCN DES to what works for surgeries, re neogitate the GP contract to pay by services supplied; ie patient consults; like the rest of the system does, and ignore the noise. When the pharmacist gets paid to do the bp on all over 40s and every day those same patients contact me to manage their one off, random, slightly elevated bp done by the pharmacist who then sent them my way, for which we get no additional funding, the penny must finally drop.
Ditch the self pity and get negotiating, hard ball. Not lilly livered.
WE do not need to win the popular vote. That’s the government’s remit.
We have to make sure primary care is resilient and sustainable for our sake and the patients’ sake and the NHS sake.
Time for GPs to grow a pair and re negotiate the contract.

Rogue 1 22 December, 2021 11:12 am

I stopped going the extra mile ago months ago
The constant work dump from secondary care, and all being asked from central government – sorry there just isn’t any space in the system
Wake up guys (and girls), they don’t give a damn about you!
You have to look after number one because none else will…