GPs link uptick in abuse from patients to NHSE face-to-face order

Exclusive GPs have told Pulse their practices have received abuse from patients as a direct result of NHS England’s face-to-face order.

LMC leaders have told Pulse that practices have seen an ‘increase in patient anger’ following the letter, and other GPs have said they are facing abuse ‘every day’.

GPs have called for NHS England to retract and apologise for the letter, and subsequent update to standard operating procedures (SOP), which last month urged GPs to offer all patients face-to-face appointments if that is their preference, while receptions must be open for walk-ins.

But the BMA has warned that many GP practices are ‘not yet safe’ for walk-in patients due to unsuitable reception areas and PHE infection prevention and control guidance updated last week recommended against unnecessary face-to-face contact in practices.

The BMA and NHS England remain at an impasse over the letter, after the BMA’s GP Committee voted to pause all meetings with NHS England until the disagreement around face-to-face appointments in practices is resolved.

Both LMCs and the BMA have advised practices that NHS England’s guidance has ‘no contractual force’, but Pulse has revealed that NHS England is monitoring how many face-to-face appointments practices are offering and asking them to justify ‘low’ levels.

Gateshead and South Tyneside LMC chair Dr Paul Evans told Pulse: ‘We’ve had an increase in patient anger and abuse since the letter, but this week is the first time we’ve had direct threats of violence towards staff.

‘With a GP/nurse/admin workforce exhausted and still delivering the vaccination programme as well as core work, to be abused whilst doing all of the above feels rather unfair.’

NHS England ‘could have retracted that letter, and their decision not to do so has to be perceived as a hostile act’, he said, adding that ‘as LMC chair, I’m aware of other practices having similar problems’.

Leicestershire GP Dr Grant Ingrams also told Pulse that instances of abuse against practice staff increased following the NHSE letter.

He said: ‘We had a couple today, and it’s definitely gone up significantly since the face-to-face letter. We’ve always had the odd one, but now it’s every day, and people you wouldn’t expect normally.

‘Some of them do directly mention the letter, saying: “You’re supposed to be seeing us whenever we want now, why’s your door still closed, open your door now”.’

Dr Dave Triska, a GP partner in Surrey, told Pulse: ‘We have had an increase in aggravated patients requesting face-to-face, even if not needed. We have had that letter quoted at us several times, leading to difficulty in overcoming unrealistic expectations. Our poor admin team have had such an ear bashing we’ve had to place a doctor in reception to assist.’

And NHS Fylde and Wyre CCG chair Dr Adam Janjua, who has also posted a video on Facebook to explain GPs’ position to patients, told Pulse: ‘We did [see an increase in patient aggression after NHS England’s face-to-face letter] – lots more angry entitled patients.’

Dr Kyle Roys, a GP in Bristol, said his practice has had a similar triaging system in place for years, but that patients are now suddenly questioning it.

He said: ‘Since NHS England’s SOP we’ve had examples of patients accusing us of not seeing patients, and asking when we’ll open. Other than a brief time at the start where we had no choice but to close the doors, we’ve been entirely open.

‘So it’s interesting that for a population that’s been using these tools for years, we’ve had people suddenly feel this isn’t appropriate. Our reception staff often get an unpleasant experience.’

Meanwhile, Dr Shan Hussain meanwhile told Pulse that receptionists at his Nottingham practice have ‘received some more abuse than average’ following NHS England’s letter.

BMA GP Committee executive Dr Krishna Kasaraneni said: ‘Unfortunately, condemnation from NHS England and certain sections of the media have fed a dangerous narrative and created confusion among patients about the way general practice is operating.

He said the frustration felt by patients ‘is often shared by GPs themselves’ and it is ‘completely unacceptable for people to take this out on hardworking practice staff, who are doing their absolute best to try to meet the needs of all patients when they contact the practice’.

‘Abusive language and even more seriously, threats of physical violence, can never be justified, and it has a severe impact on staff’s mental health and wellbeing. No one should expect to come to work and be abused,’ he added.

NHS England has not responded to Pulse’s query whether they intend to issue any apology or clarification about the letter or SOP.

However, an NHS England spokesperson said: ‘Patients should of course be able to access needed NHS services and NHS staff should never be subjected to abuse for doing their job providing that care.’