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.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk
Insightful. Increasingly over the last five years or more, patients in increasingly desperate situations are increasingly unable to access GPs working in increasingly desperate situations. The last port of call, the civil safety net when all else fails, the GP is disappearing fast. Technology is a tool, notadoctor. ‘Reform’ is not an answer, it’s a nebulous twinkly word; like ‘integration’ and ‘partnership’ – in the face of a policy of managed decline, the basic basics are not being addressed. Culpable dissociative and wilful neglect. Criminal.
Tory vandalism,destroying the pillars of our society at the same time spending all the money.Criminal indeed there’s a reason they are not cooperating with their own enquiries demands.Criminal indeed.
If you want to know what really lies behind the Tory party’s repeated use of the 3 P tools ( populism Polarisation and post truth) then take a read of this
First published in 1997, shortly before New Labour won the first of three election victories, it is called The Sovereign Individual, and is subtitled Mastering the Transition to the Information Age.
It is the product of very large brainpower, sweeps far and wide in historical research and current analysis, but its strength, especially reading it today, lies in the force of its predictions about the new millennium.
summarised quite well by Alastair Campbell
https://alastaircampbell.org/2018/08/the-most-important-book-you-have-never-heard-of-which-helps-understand-rees-mogg-love-of-hard-brexit/
‘The future is disorder. A door like this has cracked open five or six times since we got up on our hind legs. It is the best possible time to be alive, when almost everything you thought you knew is wrong.’
The driving theme of this book is the information revolution, ‘the most sweeping in history’, liberating individuals at the expense of the 20th century nation-state. Indeed, the authors argue that microprocessing will subvert and destroy the nation state, creating new forms of social organisation in the process. It will be faster than any previous revolution, and not without pain.
The ‘Sovereign Individuals’ who will gain most from this liberation are ‘the brightest, most successful and ambitious’ among us, ‘those who can educate and motivate themselves …. Genius will be unleashed, freed from both the oppression of government and the drags of racial and ethnic prejudice.’
In this bright new world, government is but a drag on ambition and success, welfare something the rich are forced to fund for the less bright, successful and ambitious. Real success, they argue, will be measured not just by how many zeroes you can add to your net worth, but whether you can structure your affairs in a way that enables you to realise your full autonomy and independence. … autonomous of government, independent of communal responsibility. ‘Persons of even quite modest means will soar as the gravitational pull of politics on the global economy weakens. Unprecedented financial independence will be a reachable goal in your lifetime or that of your children.’
The Sovereign Individuals, this vision of wonder goes on, will compete and interact on terms that echo the relations among the gods in Greek myth. ‘The elusive Mount Olympus of the next Millennium will be in cyberspace.’ Some will be as rich as Bill Gates. The ‘cyberpoor’ will be those with an income of less than $200,000 a year. But here is what Sovereign Individuals can really like about cyberspace – there will be no cyberwelfare, no cybertaxes and no cybergovernment. ‘The good news is that politicians will no more be able to dominate, suppress and regulate the greater part of commerce in this new realm than the legislators of the ancient Greek city-states could have trimmed the beard of Zeus.’
Fascinating insight. However my view is less nuanced. Fuck the Tories,
Haha
Dr No – no thanks, from what I hear, there has been a massive increase in STDs in last 2 years, and Tories are probably very high risk individuals, given their penchants for partying, disrespect for others, and dishonesty as shown in government actions.
D Callow – yes, quite enlightening. But the problem with that worldview is that it is too self-interested, and fails to fulfill needs for real love and society, and so fails all but the bottom -most layers of Maslow’s Heirarchy, leaving people emotionally empty and ‘unfullfilled’, and coindientally at very high risk of violence and loss from the unsupported poor (or disabled through covid), and ALSO from the greedy ‘ambitions’ of others pushed to personal gain by exploitation of others at any cost and without rules of fairness or respect for others. In other words, it encourages stealing, scams, and cybercriminality, by Nigerian scammers (sorry nigeria, lovely country, and I don’t know why they have gained such a reputation, unless it is their higher English language skills), or just yobs down the street.
In fact, it legitimises violent acquisition by taking from others, so is always wrong in my view.
Jaimie – I completely agree with your views in relation to the vast majority of Practices. However, there is still a minority of practices that actively cause problems for patient access by locking the doors at various times of the day; putting phone lines on divert to a recorded message that does not take messages for lomg periods during the day; failing to reply to emails; refusing to engage with e-consults; and telling patients who don’t get through within 5 minutes of opening time in the morning that they will have to phone again tomorrow, whatever the need is, or take themselves to A&E (even if for a problem AE can’t fix). There are still some such around forcing patients into the “8am scramble” (although for some it is 0830!).
We cannot honestly deny that this is frustrating patients deliberately until all examples are reformed.
It appears to be a problem with practice philosophy and management’s instructions to Receptionists, and failure to consider compassion for patients and carers.