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Should we be so angry at that NHS England letter?

Dr Martin Burnet

Dr Martin Brunet suggests the notorious missive might actually work in GPs’ favour

Nobody likes being told what to do. Still less do we appreciate being ordered to do something we are already doing. Perhaps it reminds us of that terrible sense of injustice we recall from our childhood, when the teacher gave the whole class a telling off when we knew we personally had done nothing wrong. And so the angry response to the letter from NHS England reminding GPs they must offer face-to-face appointments was both predictable and understandable. But do we need to feel so insulted?

No one condemned the ideas within the letter; we all agree GPs should be seeing patients face to face as part of delivering good care. It was the implication we are not already doing that caused offence. And there was anger at the decision to press release the letter, encouraging the inevitable ‘GP bashing’ from certain quarters of the print media, draining GP morale and turning the public against us.

And bash us they did, with relish, and no doubt some of the public joined in with the sport. Yet how much does that really matter? If our morale depended on Daily Mail headlines, we’d have given up years ago, and do we really need to care what ‘the public’ thinks? If the polarisation of political views in the past decade has taught us anything, it is that the concept of what the public thinks is much more complex and diverse than a simple soundbite. Day to day, I never meet the public, but I do meet my patients, and I certainly care what they think.

If I, like many GPs over the past six months, have maintained good access for my patients, and ensured a face-to-face appointment where needed, then a headline like the recent one in The Daily Telegraph (‘GPs warned they must see patients “face to face”’) will only make my patients feel good about their own surgery. They’ll hear how other patients are unable to access a GP, and be glad they have a practice that is there for them. The more exaggerated the media stories of frustrated patients, the more relieved they’ll feel to be registered at a well-run and caring practice. And since the vast majority of practices have been working flat out, and have indeed been open throughout this period, such a headline will make the majority of patients feel good about their practice. What’s not to like about that? Patients are more discerning than the media and ministers portray, and we can trust them to know good care when they see it.

If, on the other hand, my patients are frustrated that they can’t get a face-to-face appointment and I have gone too far with the remote model of care, then maybe I need to listen to the criticism. The problem with an initial instinct of insult and outrage is that it makes this less likely. Listen to GPs and it is clear most have worked tirelessly to meet patients’ needs; listen to patients and it is clear some have felt let down and struggled to get the care they feel they need.

We may feel aggrieved when the teacher tells off the whole class, but deep down we know someone does need pulling up short. There are more than 9,000 GP practices in the UK; most are fantastic, but some will be struggling, some will have got it wrong, and some just won’t be that great. For the sake of the reputation of the whole profession, we need to be honest that not everything in general practice is exemplary all of the time.

And what of the message that practices should be able to offer face-to-face appointments as part of a package of care? The letter provides some welcome balance (possibly even a rebuke?) to the frankly ridiculous and unsafe statement by the health secretary that consulting remotely should be the norm for the future ‘unless there is a compelling clinical reason not to do so’. Matt Hancock did not even have the good grace to address GPs with this incendiary statement, choosing instead the Royal College of Physicians. His love for the GP at Hand model is well known, but this ‘Babylon-for-all’ approach to the future of general practice is one the profession needs to steer well clear of.

Once we’ve recovered from our initial reaction to NHS England’s letter, we may come to see it as a useful piece of armour against Mr Hancock’s vision of the future, and useful leverage for our leaders as they bid for more resources for primary care, or for individual practices where they need support from the CCG to provide the care they know their patients deserve.

Dr Martin Brunet is a GP in Guildford, Surrey


Dharam Dickinson 29 September, 2020 12:00 pm

Keeping patients away from the surgery avoiding an unnecessary journey, unnecessary mixing in the waiting room, unnecessary exposure to a clinician who has seen many other patients is all a way of keeping my patients safe. Stay at home being the default should be supported, patients should be prepared for us to question their request for a face to face appointment. I will see patients where I feel this is necessary but not because they demand it.

Tim Lee 30 September, 2020 9:44 am

What incenses us is that our great and illustrious leaders, whom one might expect to be applauding the rapid, resourceful and effective response of General Practice, have instead decided to put the boot in, implying that we are essentially under-performing and work-shy at a time when most of us are on our knees with spiralling workloads.
Yes, I’m a big boy, and I don’t really care what others think about my performance so long as I know I’m performing well, but it still is infuriating that those who should know better, who represent our profession and ultimately pull the strings of NHS politics are so feverishly deluded and antagonistic

Dylan Summers 30 September, 2020 9:56 am

The article implies a dichotomy between “well run” practices which are providing face-to-face care and the rest who “need pulling up short”.

But this seems very unfair on those practices who are unable for reasons outside their control to offer as many f2f appointments as they, or their patients, want. Are these practices badly run? All of them?? Do they all need pulling up short?

Or do they need NHS England to help communicate to the public why they are struggling and what can be done to help?

Sian Stanley 30 September, 2020 7:49 pm

I would love it if this were true.
We remained open, delivered excellent care throughout- we saw everyone who needed seeing, set up a virtual ward, kept a shielded site and went above and beyond.
The articles empowered our scared, skeptical and frustrated patient population to complain more.
Our receptionists want to leave (after having to deal with double the usual amount of calls) and we are overwhelmed with patient need and complaints.
So no, there has been no perceptible positive to any of this from our perspective- sorry, it has been awful.

Colin Malcomson 1 October, 2020 11:16 am

@Sian Stanley Well said ! If all our patients were paragons of rational thinking perhaps there would be some truth to the arguments in this article — they aren’t!

Reply moderated
Lise Hertel 1 October, 2020 1:37 pm

Dr Brunet- you are so naive !

kyle nagendra 1 October, 2020 8:43 pm

Naive isn’t the half of it.
We’ve worked our behinds off providing a safe,decent service over the last six months;I’m not complaining-that’s my job.I don’t need clapping,but I don’t need chastising either;I’m not an errant schoolchild.
Let the government,NHS England and all the other powers that be get off our backs and let us do our job;maybe they should do theirs and address their catastrophic blunders and shortfalls over this period,rather than feed the GP-bashing ‘press’,because sometimes,I do care what the public think,when I come home after another trying day and turn on the news!
Kyle Nagendra

Patrufini Duffy 1 October, 2020 9:23 pm

You know when someone ‘bashes you with relish’…that sounds like calculated persecutory belittling institutionalised rape. Which it was.

Scottish GP 2 October, 2020 11:17 am

As above, intimidating power play by NHSE, cosying up with their pals in the right wing press, they hate us and it shows.

Kiki Steel 3 October, 2020 12:24 pm

I agree with the above Having had yet another awful day when I started at 7am and finally left the surgery at 10pm having had to deal with an influx of “routine” telephone appointments, required face-to-face appointments, askmyGP queries by the bucketload, the emergency triage list and of course the couple of really seriously ill patients as well, I feel that this is yet another thing to bash my morale – and I know that I am not alone by any stretch of the imagination. We, as GPs, are trying to cling to sanity in these unprecedented times, and being criticised from high by those in their ivory towers does not exactly help!

Lyndon Wagman 3 October, 2020 2:14 pm

The logic expressed is sound and reflects the skills of a GP to analyse issues in a constructive way
However the reality is that the intention of NHSE was to further undermine the integrity of General Practice using the national media as tool to do this
This is all part of the campaign to remodel General Practice in the image they want. Bye passing the agreed mechanisms of discussion under the banner of pandemic measures
General Practice will be poorer for their plans and our patients will suffer as the qualities of traditional practice, which NHSE and their supposed GP advisors, neither care for or understand are lost forever
So stop being good GPs seeking positives in adversity and stand up our patients and ourselves

Merlin Wyltt 4 October, 2020 12:20 pm

“They’ll hear how other patients are unable to access a GP, and be glad they have a practice that is there for them.”

Don’t count on it

Patient seeing me face to face in the surgery having read the Daily Mail

“It’s really bad that you aren’t seeing patients in the surgery anymore”

And Jesus wept.

Slobbering Spaniel 4 October, 2020 12:27 pm

We’ve been had, everyone.
Orchestrated attack and retraction has achieved the desired aim of focusing our attention on access, which for most of us was unnecessary, but a few very much the opposite .

Finola ONeill 5 October, 2020 1:41 pm

Brain dead response this is. We don’t care about the Daily Mail, we care about the impact this has on us doing our job. The press release undermines the operational transfer to triage and selective face to faces and in the background of a government giving mixed messaging, eat out to help out, get back to the office, while cases are rising it puts us in the middle of acting safely in a Pandemic, and implied unsafe practice by reduced face to face appts, with no acknowledgment of the risks there would be if we didn’t reduce face to face appts to necessary contacts only. This is a clueless assessment of my reality, surgery facing patient aggression and accusations for 2 weeks now. And a distinct lack of trust in us for our decision making regarding how we assess our patients. This article annoys me as much as the initial press release. If not more. Because it has come from a GP