GP practice writes 16-page open letter to patients after seeing demand double

A GP practice has written a 16-page open letter to its patients after seeing demand double in recent months and inappropriate use of its services.

The Ivy Grove Surgery in Ripley, Derbyshire, told patients it wanted to ‘provide an open and honest account’ of the unprecedented demand they were facing as a result of the pandemic and the use of eConsult.

Adopting online consulting has ‘been like opening up a brand new lane on a full motorway that was already littered with roadworks and having an instant traffic jam as a result’, the practice said.

Despite encouraging patients to use eConsult ‘in a responsible manner’, the practice has ended up overwhelmed with both online queries and its 16 phone lines remaining as busy as ever, the letter said.

Some people are reporting symptoms, such as a sore throat, earache or diarrhoea very early on and demanding ‘instant treatment’ and ignoring self-care and referral advice, the practice writes.

When patients do see the GP, because demand is so high, they come with a ‘shopping list’ of complaints adding further pressure and risk that ‘the most important issues may not be dealt with’, the letter says.

It points to the crisis in GP recruitment and retention while at the same time, the GP being the default ‘go to’ person for everything and notes while there is huge cultural change happening in use of a wider practice healthcare team this will take some getting used to for patients.

In one section, the practice calls on patients to take more responsibility for their own health – something which it says it encourages all those who register with the practice to do.

Mental health problems are now making up 10-15% of all the cases seen in the practice, the letter continues, yet many people, especially those with milder illness are actively avoiding contact with many of the services available to them or that the practice teams have signposted them to, it claimed.

The practice also asked that patients contact hospitals first about appointments, tests and results rather than the GP.

As a result of the demand, they have been facing, the practice – which also produced a 20-point one-page summary of its letter – said it would be changing its appointment system and reducing the emphasis on using eConsult.

It said: ‘Clearly this will be very disappointing to a significant number of patients who have found the service very useful.

‘This should not be considered a failure. In fact, we feel the way we have promoted, managed the service and aimed to resolve patients’ issues through eConsult quickly and efficiently has significantly increased its use, so we are almost a victim of our own success.’

‘We will now be returning to a more traditional service, similar to that which existed before covid, in which appointments will be allocated to those in clinical need,’ the letter concluded.

A spokesperson for eConsult said it supports the practice’s decision to limit use of the online consultation service, noting a ‘small minority’ of other surgeries had done the same. Patients are urged to ‘use digital services responsibly’, said the spokesperson.

They said: ‘Providing patients with the best possible access to healthcare while avoiding GP burnout is a delicate balancing act at the best of times, let alone during a pandemic.

‘eConsult has been designed by practising doctors as a triage tool to address the specific capacity issues outlined in the open letter. If used correctly by patients, it reduces pressure on GPs by flagging and prioritising urgent patients and directing people with milder symptoms elsewhere.’

The news comes as March data from NHS Digital revealed that GPs consulted a record-breaking number of patients last month and as Pulse’s recent workload survey revealed that GPs are working 11-hour days.

NHS England’s primary care director Dr Nikki Kanani acknowledged earlier in the month that general practice is ‘feeling really difficult at the moment’.