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Are we really still all in this together?



What a success the Covid vaccination story has been in primary care.

As ever, GP practices have thrived when left to manage themselves. It made me so proud to be part of not just our team at Manor View Practice, Watford, but of primary care in the UK. And as lockdown restrictions started further easing today, quite rightly, we all have to look at adapting to the changing environment. Nothing new there.

There are so many questions to answer. Do we go back to face-to-face for everything? But how would we socially distance in the waiting room?  Do we stick with a mix of remote consultations and face-to-face for a little longer? Does this work for our patients?

The balance is a delicate mix of patient want, patient need and safety – all in the midst of a pandemic which hasn’t gone away, lest anyone forget. Whatever model a GP practice followed pre-Covid would have been because it’s what that practice felt was appropriate for its patients. There is no perfect system. No one size fits all – otherwise we would all be doing it.

But the point is that we each know our patients better than anyone, and so it’s only right that we decide on how we develop the model as the pandemic permits. So far, so good. But there is another factor at play here, as we all know. There is a subset of the media that wants a story to fit the narrative of GPs refusing to see patients. And their thirst to find something that fits that agenda is bordering on unquenchable. 

So it was beyond shocking that the SOP released by NHS England late last week tipped the balance very much in favour of patient want, not patient need. Some of it made sense, but we could all see that there were elements just dying to picked up by the mainstream press. Any of us could have written the forthcoming headlines: ‘NHSE forces GPs to open doors’ (we’ve never been shut); GPs told to see patients face-to-face again’ (we never stopped).

There had been no discussion with anyone at CCG level, nor the BMA. The effect – primary care is on the back-foot. As GPs, we’re often reminded that we’re the gatekeepers of the NHS. With such a minuscule budget, we have to ration resources based on clinical need – it’s what we do and it’s what we’re good at.

The pandemic has shown us so many ways of interacting with our patients – again, GPs adapting, thriving and utilising limited resources to great effect. So why send this SOP? Why not consult with the BMA beforehand? Anyone working in a communications department could have seen the effect that was forthcoming – whatever your appointments system, patients can ask to be seen face-to-face. But it’s not in the GMS contract, we’re reassured – where it states that a GP determines how and if a patient is seen, depending on clinical need. That’s all well and good, but is that really going to wash with a demanding patient waving their copy of the Telegraph

The only conclusion I can draw is that either this was done on purpose to create a larger wedge between the powers that be and us so it’s easier to blame GPs when it all goes wrong, or NHSE clearly doesn’t understand primary care. Neither option is palatable. 

Dr Ketan Bhatt is the lead GP Partner at Manor View Practice, and clinical director of Manor View Pathfinder PCN, Watford

READERS' COMMENTS [3]

Patrufini Duffy 17 May, 2021 6:40 pm

An SOP sent to scapegoat you for hospital waiting times, and public dissatisfaction at life in general, and a UK society riddled with chronic chaos and trivial ill health. You are like the alcohol to their woes, professionals on the cheap and no payment per visit. GP machines, hoovering up with no end in sight, hopelessness, and whose flames are burnout, with no fragrance or glow. That thorn of an SOP and “tone” lacks respect, trust and recognition, sent by kids who signed it off. Your timeless colleagues are dead. And they couldn’t care less if you were next.

David Church 18 May, 2021 11:57 am

No, we are not all in this together, and we never were!
All along ithas been that corrupt government looking after their own interests and nepotism, with complete disregard for the lives of the healthcare workers and the general public whoom they were meant to protect.
Not even the NHS management were in it with us – they have their own agends, their own egos to feed, in their distant white isolation towers, surrounded by private medicine and private carers. Sad to say, many of them used to be colleague professional doctors and nurses, but tehy no longer are: they are now corrupt self-serving agrandisers.

Dominic Hennessy 19 May, 2021 7:54 pm

Thank you Ketan for this well balanced and nuanced view.
I don’t think I have ever seen a workforce as tired and beleaguered as we are all feeling right now, and clearly the NHSE and gov.uk narrative fits the agenda. It is disappointing that our own primary care colleagues cannot see how damaging and disparaging this is.
NHSE might get what they wish for, but I doubt they have considered the law of unintended (at least from their point of view) consequences: The more damaged the relationship is between patients and their primary care team, the more expensive primary care is likely to become.
Trust is a valuable resource in any relationship. None of us trust NHSE, but erstwhile, most of our patients have trusted us. Erode that at your peril.