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Truth is drowned out as media attacks intensify

Truth is drowned out as media attacks intensify
Daily Mail campaign for face-to-face GP appointments

While the media write that general practice is ‘closed’, a Pulse survey on access finds otherwise. Caitlin Tilley reports

‘It is high time GPs started operating in the way that they did before the pandemic and offering face-to-face appointments to everyone who would like one.’ These are not the words of a reactionary Telegraph columnist, but of the health secretary, Sajid Javid, spoken in Parliament last month. 

September was a particularly brutal month for GPs, as face-to-face access dominated the news agenda. The Daily Mail kicked off a campaign to assert the ‘right’ for patients to have face-to-face appointments, claiming the support of the Prime Minister (conveniently ignoring that no such right exists, at least not in the GP contract). 

What the GP contract actually says

‘Contractor must provide [essential] services… within core hours, as are appropriate
to meet the reasonable  needs of its patients’

Source: Standard General Medical Services Contract

Meanwhile a spate of articles have been proclaiming that GP practices are closed, GPs are not working hard enough and are refusing to see patients. Allison Pearson in the Telegraph went as far as to say she was ‘not surprised’ GPs had received a torrent of abuse.

Alongside this abuse, there have been shocking casualties. Four staff at one practice in Manchester were hospitalised after a patient attack. The BMA said if coverage continued in the same vein there would be more abuse and attacks.  

But amid this, the truth seems to have been lost. And the truth is face-to-face appointments are continuing and waits are coming down, and the fact face-to-face appointments are no longer the default should not be lamented.

An exclusive Pulse survey of 1,000 GPs found  50% think a return to pre-pandemic levels of face-to-face appointments is not possible, citing problems around infection control and increased demand throughout the pandemic. Eight in 10 think a return to those levels is unnecessary, with just 9% saying it is desirable.

Our survey respondents point out that many patients won’t be willing to accept the removal of the online access they have become accustomed to, but also that the flexibility afforded by a mixed model has benefited care and resulted in waiting times decreasing for face-to-face and remote consultations. 

A new way of working 

As one GP partner in Lanarkshire puts it: ‘The myth that people are waiting days and days for a telephone appointment is unhelpful and demoralising as we are working our arses off… all patient requests are dealt with on the day they contact the surgery unless it becomes unmanageable.’

The latest publicly available data for England show an estimated 27.9 million appointments took place in July. In June it was 31.1 million. Go back a year, before the Covid vaccine campaign got under way, and the appointment figures for July 2020 were 22.7 million.

And the idea that general practice is closed doesn’t stand up to scrutiny. Just over 15 million patients were seen face to face in June, while 10.6 million had telephone appointments. The figures also show that 45.6% of appointments took place on the day they were booked.

Dr John Thompson, a GP partner in Greenock in Scotland, says that while a return to pre-pandemic levels of in-person appointments will be possible in future, ‘we may still wish to triage all face-to-face requests as many can be safely and effectively handled by video, phone or email. This also stops appointments being booked for things that do not need a GP’s expertise or for more minor self-limiting illness.’

There are also fears that patient expectations won’t be met if GPs return to more face-to-face appointments. Many patients have become used to the easy access afforded by remote access. 

Dr Thompson says the flexibility of a mixed model has helped care but adds: ‘We can be reached by so many methods now that it’s hard to close the floodgates.’

A Gloucestershire GP, who asked not to be named, says: ‘Because of the increase in demand, phone triage is required to ensure there is capacity to see those who clinically do require a face-to-face assessment. Undifferentiated face-to-face booking will overwhelm capacity and waits will be extremely long, leading to potentially unsafe care.’

There are fears about GPs’ own health: around six in 10 respondents say they are concerned about their physical  health with the return to face-to-face appointments, with 21% ‘very concerned’.

The mixed model is showing benefits for patients. The average wait is nine days for a face-to-face appointment, and about a week for remote consultations. In August 2019, the average wait for a routine appointment was 15 days.

Merseyside GP partner Dr Eithne MacRae says any delays in face-to-face appointment times are ‘usually down to [the] patient’s schedule’.

Media attacks fuel abuse 

But the pressure to deliver consultations in such a variety of forms is taking its toll on GPs. One GP partner said: ‘I regularly do a 13-hour day now and am struggling with the physical and mental pressure. We cannot keep up with the demand.’  

This is not unusual. A GP from Leeds added: ‘We’re working 12 hours and more without a break, with 40-50 consultations a day, as well as results and paperwork.’

Media attacks on general practice have caused real harm. Nearly three-quarters of GPs are experiencing increased abuse compared with before the pandemic. 

Dr Paul Richardson, a locum GP in Huddersfield, believes the abuse is ‘most likely associated with the frustrations of patients who perceive they need an appointment and we consider they do not.’

The toxic debate has had an impact on  relations between the BMA and the NHS. In May, the BMA GP Committee (GPC) voted to cease all negotiations with NHS England as a result of its letter in May telling practices to ‘respect patients’ preference for face-to-face care’, which fuelled adverse coverage. On 3 September, the GPC voted to resume talks, although some members resigned in protest at this. 

But in response to the Mail’s campaign, BMA council chair Dr Chaand Nagpaul wrote to Mr Javid demanding an ‘urgent’ meeting about ‘what support GPs could be offered to manage the unprecedented rise in workload to meet the needs of all patients’. The letter took the Government to task for siding with media outlets who are ‘scapegoating’ GP practices over patient access.

The meeting was granted, and BMA GP committee chair Dr Richard Vautrey used it to call for ‘clear public backing for GPs’ acknowledging ‘the huge pressure they are under’, urgent investment in primary care to ‘remove unnecessary bureaucracy’ and a Government commitment to work with the BMA on ‘a national campaign to stop the abuse of NHS staff’.

In perhaps the most major development however, the BMA has launched a survey into general practice’s response to the current abuse and workload crises, asking whether GPs would consider leaving the NHS or handing in undated resignations among other actions.

How the health secretary responds could be one of the defining factors of his time in office.  

Pulse is currently sending letters to the four UK health secretaries, and heads of the NHS with results from our ‘Building a Better General Practice’ campaign, and from this survey. We will feature their responses in future issues of Pulse. 



Please note, only GPs are permitted to add comments to articles

Roger Boyle 4 October, 2021 10:17 am

A common tactic of this government is to ” blame someone else.”
The chronic underfunding of the NHS is HMG’s ,but it’s easier to blame lazy GPs!!

Chris GP 4 October, 2021 10:32 am

No HGV drivers – well – the pay and conditions are crap and because they have to do CPD and the like, there is a retirement bubble… Government line “the industry knew this was coming – it is the employers fault!”
GP shortage…..same reasons as above – Government line ” they are lazy”.

Kevlar Cardie 4 October, 2021 11:37 am
Neil Tallant 4 October, 2021 2:50 pm

The issues are multiple but again boil down to actual needs vs perceived wants. If the NHS could just get on with what is actually needed, we’d all be coping; it’s the wants (and bureaucracy) that blow the ship out of the water and dig the pit ever deeper. The NHS is forever being asked to do more but nothing is ever taken away. There are now so many ways to skin the cat that the “innovators” have lost sight of what a cat is. GPs need to take back control of how they work. Put simply the time is now for ultimatums. We’ve been arguing underinvestment for over 10yrs now. The status quo is no longer any option. Work patterns will inevitably change for all manner of reasons but the pattern has to primarily suit General Practice.

Decorum Est 4 October, 2021 3:16 pm

‘The issues are multiple but………’
That’s so true but…
The major issue is that GPs just repeatedly roll over for another good hammering/xxx/yyy etc
The resolution is simple….charge a proper professional fee for professional services.
(if individual GPs want to do pro-bono work, that is their individual choice)

Patrufini Duffy 4 October, 2021 3:23 pm

Hats off to the narcissists.
What is sickening, is that this orchestrated catastrophe might all be irreversible. Patient versus doctor, Government versus doctor, doctor upset and leaves.

NK can write a blog about “innovation” and “vaccine uptake” all day long, and run away from the but run from the biggest disease on her and Wally’s desk. As Hancock said “check your tone” and Javid said to carers “go get another job” if you don’t want a vaccine. It’s all an inside job.

Patrufini Duffy 4 October, 2021 5:55 pm

The best thing about all UK Governments especially this blue suit and party dress lot, is smokescreens. Shame about the Pandora Papers. And the impending revolt of social inequality. Once the middle class steps aside, they’ll be in a spot of bother “up there” in the tower.

But in other news:
– Harry and Meghan
– China
– England footballer’s accolades
– The best brunch and G+T spots in town
– Holidays and more boozy holidays
– The heat wave coming in weather
– Crap useless GPs
– Bad people in other countries
– Crap GPs

Mark Cathcart 4 October, 2021 6:24 pm

Perhaps: the comfortable relationship between some BMA leaders and departments of health need to be challenged: the leaders of our profession have in my opinion been too close to politicians to effectively challenge them on the real problems in primary care. In what other field would our trades union forget it’s members interests and place employer interests above those of its paying members? I left the bma some years ago as I felt the cozy relationship between these two parties was not representing my interests as a gp

Cameron Wilson 4 October, 2021 7:34 pm

Spot on Mark, we are on our own! We should have been out of this toxic relationship years ago! Strategically we should have had an alternative model being considered and worked up a long time ago! I know some will say sort yourself out eg locum on your terms but would have been good to have had an alternative with peer support without the “Every man for himself ” which we seem to be heading!

Reply moderated
Turn out The Lights 4 October, 2021 8:51 pm

The BMA have failed do they deserve you money,if you still pay it .I stopped a few year ago and do no regret it.Nothing has happened to change my mind since.They continue their inept chuckle brothers act to me to you while the nhs and the people they supposedly represent slowly dwindle away.

Patrufini Duffy 4 October, 2021 9:22 pm

Found an article on your colleagues called dentists. Who get the veneered privileges:

Wait for the slaughter, oh, it’s not coming.

Josef Kuriacose 4 October, 2021 10:58 pm

There is no question that patients feel they have to wait to see GPs, as they do for hospital appointments. On the other hand, we GPs are working workloads and hours beyond our tolerance. No one is happy. It is not a complex Ramanujan puzzle, the maths does not add up, simply there are not enough GPs and our Contract has no number boundaries. It is open ended, a patient can wish a 100 consultations a year, and we have to provide them. So, as consultation rates/ year have roughly trebled in the last 25 years [ 2 to 6 ], with increasing complexity and lack of secondary care, we have to step up.. Otherwise, we are lazy.
But the problem is OURS. We ACCEPT an open ended Contract. If we do not provide it, irrespective of how hard we work, we are in breach of our terms.
We need a new Contract, based on number of average consultations a GP can provide in total per year.
Otherwise, no matter how many hour we work, we will be seen as lazy for not providing enough. It is not a patient problem, it is the Contract we accept.

John Glasspool 9 October, 2021 8:56 pm

Josef, the last time GPs were asked, 80% of them voted to accept the contract. Some of us who didn’t regarded them as foolish.

Josef Kuriacose 10 October, 2021 11:06 am

Absolutely John. I have spoken at BMA ARMs on this crazy Contract without number boundaries, and have been voted down. As a result we end up working 14 hour days with 40+ consultations and still labelled lazy, because this workload is not enough to keep up with the demands that now probably need 20 hour days with 60 + consults. Since we now consistently complain about our hours and numbers seen and workloads, perhaps we should begin to define an acceptable and safe number, say 26 appointments a day. If waiting times increase, it then becomes obvious there are not enough GPs as we GPs have reached the limit of safe working, as with pilots or HGV drivers.