Chatting with Copperfield about his column, I was playing devil’s advocate (no, not that one). What exactly do you want, I asked. You complain about too much work, then, when you get support, you moan about work being taken away.
Using a voice normally reserved for a parent who’s brought little Johnny in with a runny nose, he explained the three ways to tackle rising GP workload: divert the work; contain the work; and reduce demand.
In England, especially, the focus has been on the first. PCNs have been given all types of healthcare professionals to remove work from GPs. But diverting the work is the worst option. It leaves GPs to deal with more bureaucracy and the trickiest patients. It also has the effect of both making them redundant (see Copperfield) and overworking them when the HCPs are off sick, or funding is removed.
Yes, the pandemic hit in that time but that seems mostly to have affected the nature of workload rather than the volume. The problems of face-to-face contacts have simply been swapped for those of remote consulting. A year on, practices are back up to normal appointment levels.
Increasing GP numbers would of course help, but create more supply and it will be filled, just like adding an extra lane to the M25 or an extra bin in the kitchen.
So how about containment? Cutting working hours or capping appointments would help GPs but politicians will always put voters’ demands for convenient access over the welfare of GPs.
That leaves reducing demand. The obvious route is to introduce a charge to use GP services – as a couple of our bloggers argued last month. Stop making services free, they said, and the demand will reduce. I am uncomfortable with this for many reasons, but mainly its potential to increase healthcare inequality.
Could a culture change in patients’ relationship with the NHS ease demand? For all the errors of the past year, the ‘Stay home. Save lives. Protect the NHS’ message did seem to get through. Keeping ‘Protect the NHS’ could reduce demand. And there is a part of the NHS that does curb demand in this way: A&E. It even requires 111 referrals now. But A&E is hardly the poster child for safe levels of work.
There are ways to reduce demand – but they are not easy.
First, politicians could make brave decisions on what the NHS can provide. Prune screening. Instruct NICE to tighten thresholds for two-week referral and approval of new treatments. These are unpalatable for everyone, but they would work and are achievable.
There is a palatable solution, however, that won’t affect patient care. We need to acknowledge that patients who use GP services do actually have problems – but the causes are largely societal. Austerity has had a disastrous effect; deprivation is the biggest predictor of poor health, so closing the equality gap is the only real solution.
Since that will never happen, good luck with appointing your new practice physiotherapist!
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org.