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