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

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.’