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Face-to-face should be about need, not preference


standard operating procedure


The current narrative of GPs across the country is one of despair, frustration and despondency that I’ve never seen before. It’s been deeply saddening to hear colleagues share their plight and anguish of how this past year has been, working through the pandemic.

When we had to close our doors to patients at the beginning of the first lockdown, it was only to enable access by other means – something we all knew would eventually evolve in primary care. But never had we envisaged it happening so quickly, and under such circumstances.

Our practice never closed. We’ve continued to manage our 15,000 patients – the young; the old; the pregnant; those who were acutely ill or chronically unwell, through both telephone and video consultations.

Those who have required a face-to-face review have always been seen. We’ve had to accept these new ways of working, knowing that they’re not ideal but are intended to ensure our patients are being managed in the safest way possible.

For the many who lost loved ones and couldn’t visit families, it was their GP, a familiar voice, who was so often the main source of comfort and support.

Our social prescribing teams have continued to be an immense source of support for our elderly, frail and vulnerable patients when uncertainty and anxiety were paramount in all of our lives.

Primary care never ceased to function in its role to support and care for its local community. The Covid vaccination roll-out is just another example of the additional workload that’s come our way and how GPs have risen to the challenge of meeting these targets alongside everything else.

We know the pressures that our secondary care colleagues are facing – we have seen the plight of ITU staff and tried at every step to do whatever has been in our capacity to support a healthcare system that’s at the brink of collapse.

We’ve had to learn to work in ways that most of us were unfamiliar with – let alone felt comfortable with – and acquaint ourselves with technology we’d never used before. We’ve had to make difficult decisions with our patients, justifying our management plan in accordance with what’s both right and safe for them.

Throughout this, many GPs have been dealing with their own losses and illness, with many colleagues being taken seriously ill with Covid themselves.

As lockdown restrictions ease, and Britain opens up once again, nothing will have changed for the thousands of GPs who continue to take the brunt of all that this pandemic has left us with – the exceedingly worrying levels of mental health crisis we’re facing; the rising number of cancer cases; and the significant delays in routine operations, alongside the tiredness, exhaustion and mental and physical fatigue that’s taken its toll on so many.

To say that all practices must enable face-to-face access is both unreasonable and unsafe. Patients should continue to be triaged safely, with their being seen face-to-face determined by clinical need, not preference.

If the voices of GPs across the country continue to go unheard, many will continue to leave the profession as they’re already doing so – and what a grave injustice that would be.

When the trust, care and compassion that we work so hard to nurture in our patients isn’t evident in those who are supposedly there to support our cause, it will sadly leave many doctors with no other option.

Dr Sadiya Ayaz is a GP in Wandsworth, South West London

READERS' COMMENTS [5]

Concerned GP 25 May, 2021 10:47 am

Absolutely correct. Thank you for such a common sense and safe approach.

Darren Tymens 25 May, 2021 11:44 am

An excellent article.
If only NHSE had such insight – but either the true state of affairs isn’t being reflected back to them by their own GP Directors, or the GP Directors are being ignored (and are still signing whatever letters are being put it front of them).
But despite all the furore in the profession, and GPC’s own actions last week, what have NHSE done?
The actual SOP, when published, doubled-down on the NK/EW letter. There has been no compromise and no apology, and in fact the SOP made it worse by insisting on 24 hour online consultation access.
NHSE and NK (despite widespread calls for her resignation) have gone silent – it is the way of modern politicians to never take responsibility, never say sorry, and to keep quiet and hope everyone will move on and forget about it.

Patrufini Duffy 25 May, 2021 2:54 pm

Funny how others think they know what you should be doing. Like telling a neurosurgeon when he must check cranial nerves and cardiology when to examine the pulses. This is all about command and conquer – nothing more, wedging you between them and the public. You are the wave-breaker – but the funny thing is that the storm does not stop. You know what is rights – see what you need to see, and deal with the rest remotely. Period.

David jenkins 25 May, 2021 4:47 pm

i am a locum gp. i limit my work to two full days a week. i am 71, and down to one lung capacity. when in work i am happy to pull my weight, see extras, deal with silly requests, go without lunch etc etc etc. i am fully indemnified, and any cock ups are mine alone – for which i am responsible.

this morning, four separate surgeries have been in touch wanting cover on various dates, so there’s plenty of demand.

i expect to be able to triage stuff out if i think appropriate. if i am told how i should work, and which patients i should see in person, by someone who is unqualified, i shall not be going back to that surgery, and they can get some other mug to do it.

if those clowns “at the top” think they can boss me about, and tell me what to do, and how to work, they are mistaken. and there’s no point trying to bully me – i went to boarding school !!

if they somehow change the “rules” to force me to do what i’m told, then i shall leave altogether, and the precious nhs will lose yet another doctor with over 40 years experience !

i continue to work because i actually enjoy it !

if this stops, then i shall leave.

kanani, waller etc take note.

Dave Haddock 27 May, 2021 1:42 pm

Surgeries that are being paid to provide a service but refuse to offer face to face consultations are taking money under false pretences. For once NHSE is right. It’s shameful.