Pulse’s latest investigation has revealed the damaging impact of rising abuse towards GPs and other practice staff. Here, Dr Mike Holmes, chief executive of GP provider Haxby Group and a partner across its York surgeries, describes how one of his practices in Upper Poppleton now closes every day at lunch due to abuse from patients.
Upper Poppleton is a commuter village on the outskirts of York, which Dr Holmes says is ‘affluent’ and ‘full of professional people’.
‘What was happening in Poppleton was that patients were being verbally abusive towards receptionists. An example is that one patient called a receptionist a “worthless person” with a couple of expletives thrown in there.’
The receptionist broke down into tears, had to go off early, and the team had to find cover. Dr Holmes says this occurred when the receptionist wasn’t able to find an appointment for the patient. She tried to explain the way requests for appointments are triaged, but the patient wouldn’t accept it, saying they wanted to book an appointment the way they always have in the past. ‘They couldn’t quite understand that the system had changed and evolved, and it was due to the fact there is unprecedented demand’, Dr Holmes says.
Instances like this have become so common that staffing has become an issue, pushing the practice to the point of closing the surgery for half a day every day.
‘I think for people, often young people trying their hardest in really difficult times on living wage, to be spoken to like that is not really acceptable. And I raised this at a parish council meeting, but it didn’t go down very well because the patients took it really personally – and of course, they’re not all doing it, by any stretch.
‘Across the Haxby Group’s three places we’ve got 13 surgeries, and people are saying to me “I really want to work for the Haxby Group but I don’t want to work in Poppleton” – that’s receptionists and doctors. So it’s affecting wellbeing and making people make choices about where they would like to work.’
Dr Holmes praises the work of the receptionists, who he believes are often misrepresented in the media.
‘The receptionists have done amazingly well – they were ever-present during the pandemic, they weren’t on furlough, they were working from the surgeries throughout, putting themselves and their families at risk. They try really hard, and they get an awful press in the popular media about being dragons and refusing appointments. They don’t do that at all, we work really closely with them. They work with us as part of the GP team to make sure that patient gets seen appropriately. But to have receptionists in tears is unacceptable.’
‘Everyone’s under pressure, everyone’s worried. It does manifest itself sometimes in unpleasantness, but if we come together and have meaningful dialogue, then we can try to sort it out together.
‘There was definitely a spike in verbal abuse towards receptionists post-pandemic and caused by increased demand and backlog in general practice and in hospital. But the engagement – with the parish council, in the news – has helped. We’ve pledged to meet them regularly, once or twice a year.’
Across the Haxby Group surgeries, the problem of abuse seems fairly unique to the Poppleton practice, according to Dr Holmes.
‘It is interesting that we’ve got this middle class village on the outskirts of a relatively affluent city, and that’s the place where we’re getting most of this complaining. It’s this balance in the NHS between need and want. When you’ve got very health-literate populations and they absolutely know what they want and they’re not shy in telling you, the reality is we’re often not resourced to provide that.’
Dr Holmes says GPs sometimes receive abuse too, particularly on phone consultations. He stresses it’s a minority of patients, but that the psychological impact is significant.
‘When you’ve got clinicians and staff on the point of burnout because it’s so busy and there’s not enough of them, it doesn’t take much to upset them. They’re more fragile than ever before. I’ve been a GP partner for 21 years and I’ve never seen it like this where wellbeing is at an all time low and they’re fragile. The resilience is low.’
But he expresses compassion towards patients, saying the staff don’t blame them.
‘We understand that they’re frustrated, that this is difficult. We understand that particularly for more elderly patients it’s changed – we’re trying to use more technology. We don’t blame the patients. It’s just when it becomes unnecessarily offensive – there’s no need to be like that. You can say to someone “that was really difficult, I didn’t get what I want”, you don’t have to swear and tell them they’re worthless. It becomes personal. Everyone’s entitled to express frustration, and we get it, and there’s a certain amount of resilience to that. But I think when it’s directed personally towards individuals, then that crosses a line.
‘We are on the same side as patients. What we’re trying to do by engaging with them is get that message across and work with them. It’s not like we are deliberately trying to make life difficult for patients. What we’re trying to do is provide the best service that we can with the resources we have, both financial and human resources. We desperately try to provide the best service we can.’