Editor Jaimie Kaffash argues that despite the media’s rhetoric, general practice is the most accessible part of the NHS – and as a result, it is a conduit for all patients’ frustrations
The saddest thing about this month’s cover feature is that it probably isn’t surprising. Stories of GPs and practice staff facing physical, verbal and social media abuse are commonplace. There has been lip service from policymakers to denounce such abuse but in reality, their approach to general practice is fuelling it.
The relentless focus on access – especially but not only in England – might not be designed to encourage abuse of GPs and their teams, but it contributes. Of course, frustration from patients unable to get through to their practice is understandable. But access is a huge issue in every part of the NHS, from A&E to mental health services to urgent cancer referrals.
Yet general practice is absorbing the bulk of patients’ frustrations and the associated abuse. This is not to disregard the abuse faced by, say, A&E doctors and staff. But the stories told to us are different to the flashes of anger faced in A&E. Our case studies involve persistent hostility, premeditated vandalism and social media vendettas. Some patients display a visceral hatred that goes beyond frustration.
One of the reasons is that the pressures are less visible in general practice. Compared with the overt chaos of A&Es and hospitals more generally, GP waiting rooms look relatively serene, as much of the demand is through telephone lines, or econsult. As a result, patients perceive GPs and their staff to be less overworked than secondary care teams.
But I believe there’s a more fundamental reason for the abuse practices face, and therein lies a bitter irony: that, despite the rhetoric of ministers and the media, general practice is the most accessible part of the NHS. As a result, it is a conduit for all patients’ frustrations.
General practice carries out 90% of all NHS activity, with patients averaging around nine contacts per year. GPs remain the patient’s advocate, even if the loss of continuity plus overwhelming demand has lessened this. So when patients are failed by the wider NHS, practice staff become a convenient punchbag.
And while booking a GP appointment might be less easy than patients would like, they will get access to
a GP or another healthcare professional – even if it involves marching into reception. The same can’t be said about most other NHS services. Patients will also believe GPs have priority access to hospitals’ patient liaison services, when in fact they are using the same numbers as patients themselves.
What’s more, GP services are more accessible than other public services broken by a dozen years of austerity. When someone has been ground down by problems with housing or social care, their GP is often the only port of call. After facing brick walls elsewhere in the public sector, a struggle to contact a GP can be the last straw.
Readers might think I am showing too much sympathy for aggressive patients. It goes without saying that abuse of any kind is unacceptable but I believe much of it is a symptom of structural issues, for which GPs and their staff have no responsibility yet bear the brunt of the fallout.
All of this, of course, makes NHS England’s solution of improved telephony systems even more insulting, suggesting as it does that deep structural problems can be sorted through a minor technology upgrade.
Sadly, until the decay in public services is reversed, practices will continue to be a convenient scapegoat, with the unfair abuse that entails.