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