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Winning back hearts and minds


hearts and minds


In my nine years at Pulse, I can’t remember the profession being more angry than they are right now. I’m not going to tell you why that letter from NHS England was so insulting. You know far better than I. It’s one thing doing a thankless task, but to attract these thinly veiled criticisms when you are close to burnout as a profession is another thing altogether.

I can, however, speculate on the longer-term implications of this letter. And sad to say, they are not good.

First, by pandering to the reactionary parts of the media, NHS England have shown that they are willing to sell GPs out. It was only this month that they put out a statement to say that there were ‘no plans’ to return to face-to-face appointments as standard. And that NHS England were putting out a ‘wider communications and media plan to help mythbust that awful line [that] general practice is not open’. Yet following a campaign from the Mail on Sunday and a column in the Telegraph, they are perpetuating this ‘myth’ .

What this tells us is they will happily go along with the scapegoating of GPs if it is politically expedient. And, knowing they can pull off such an audacious move, we can suspect some more confidence from NHS England in promoting their agenda in future contract negotiations.

Which brings me to my second point – I am fearful around what the NHS England agenda is. When I get full conspiracy theorist, I ask whether NHS England was reacting to the media campaigns, or the media campaigns had been given a tip off by NHS leaders, because this fits into their agenda.

Having had three years of Matt Hancock’s appy talk on the wonders of remote consulting, now we have this letter. Which, to me, potentially suggests a two-tier system of general practice, with ‘traditional’ general practice taking on complex face-to-face appointments, and digital providers dealing with the simpler stuff. The fundamental problem being who decides on what is simple.

But perhaps my third point is the biggest concern: the damage this letter is causing is to the patient-doctor relationship In reality, the guidance itself has no teeth – there is no contractual mechanism to punish GPs who limit face-to-face appointments only to those who need them. But now we have a situation where patients’ rights to dictate their level of access to a GP has been endorsed by the health authorities at a time when the waiting room has effectively shrunk in terms of numbers it can hold. This isn’t simply a GP workload issue, though this is massive. It is offering patients a service that is logically impossible. And who will patients blame? It won’t be NHS England or the Mail on Sunday.

So what can GPs do? I’m afraid the idea that GPs can work to rule, take strike action or stop doing the Covid vaccination programme, for example, sounds great but is unrealistic, and I am not sure how happy the majority of the profession would be with such action. It certainly won’t reduce your stress levels.

Instead, GPs need to be setting the agenda around what general practice should look like. Because at the moment, it is the Mail on Sunday, the Telegraph, Matt Hancock and previously Jeremy Hunt who speak ‘on behalf’ of patients. In their vision, patients want to see their GPs face to face, but also immediately on an app, and they want to see the same GP, on Saturdays and Sundays as well as during the week.

But here’s the thing: knowing what patients actually want is one area where GPs really are ‘best placed’. You know what good care is: it is continuity; it is lengthy enough appointments to actually get to the heart of the problem; it is focusing on conditions you can improve, not ticking QOF boxes; it is putting safety ahead of convenient access. And most of all, good care is provided by relaxed, content GPs.

So the profession needs to set out their vision of general practice to the public – one that suits both patients and GPs. And really shout about it – use the same tactics used by the reactionary newspapers, and the politicians themselves.

Those with an agenda are speaking on behalf of patients, and damaging the patient-doctor relationship at the same time. It is time to redress the balance.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk.

READERS' COMMENTS [6]

Shaba Nabi 19 May, 2021 9:34 pm

What a fantastic blog Jaimie and very timely in advance of a GPCE meeting tomorrow

Thank you!

Patrufini Duffy 19 May, 2021 10:38 pm

Poignant summary. They all set you up to FAIL. The GMC and CQC who you pay, watch on like vultures. *The purest sickness in medicine. Yes, they sold you off, wedging you between them and demanding public. And the whole world is invited to this nightmare chirade. The only way is to sadly take the hospitals down with you. The chain reaction must be system-wide. You can actually make that happen. Then the public will show distaste at the system, not you. Do not save on referrals. Move the patient in. Get them off your books. The Americans are here already in OPEROSE, HCA and friends. That is part of the hidden agenda Jaimie. Harvard graduates infiltrating NHSE. This NHS Digital rectal is without consent, and very very deep. NHSX-rated perhaps. Tread carefully, in the opposite direction, or consciously move forward.

Vinci Ho 20 May, 2021 6:35 am

Many thanks , Jaimie , for providing the real voice for us , as always .
I am glad you brought back the word , continuity ( of care) .
People seems to have forgotten this fundamental principle and telos of general practice in NHS and indeed , it should governs all arguments on any debate about how we should move forward and what shape general practice should become . As I wrote under another article on this platform, presumption of more quantities will result in better quantities is farcical , at least , under current circumstances colleagues are facing . Remember even before COVID-19 , people were already talking about ‘working by scale ‘ , expanding access to primary care and of course , five year GP plan( with PCN ideology) etc . But what is the realistic picture today ?
I agree that redressing a balance is always the primary objective but it is easy said than done if the hierarchies remain ignorant but also politically charged ……….

Kosta MANIS 20 May, 2021 10:52 am

Jaimie, I’m glad to say that I do not share your concern: “But perhaps my third point is the biggest concern: the damage this letter is causing to the patient-doctor relationship”. Apart from a few ‘disgusted of Tunbridge Wells’ and a few more who can’t get to the pub, the vast majority of patients remain loyal to their GPs. As always, things will be sorted out eventually, proving once again that ‘rumours of general practice’s death have been greatly exaggerated’.

Concerned GP 21 May, 2021 5:43 pm

Thanks so much Jaimie. In a truly awful week for general practice, Pulse has stood out as one of the only publications that writes with balance and fairness. I understand completely what you say but I fear that many GPs are just too exhausted and feel that the establishment is very much against us and has an agenda and so “what’s the point?”. There were over 1500 (virtually all negative and vicious) comments about GPs in today’s Telegraph in response to the GPC decision. They are spinning a venomous campaign and it certainly feels like the media, parts of the public and NHSE are waging a war on us and we honestly don’t know what to do to defend ourselves. I don’t think any other profession would stand for the abuse that we receive.

Vinci Ho 22 May, 2021 7:26 am

Interesting development and most definitely, sparking off serious debates .
In the beginning of this pandemic , I was looking for literature about the relationship between pandemics and human conflicts (war at the most serious level ) in history. I think ,almost invariably, pandemic is a call from nature to human beings that the ‘old’ ways could not carry on again and something had to change . As I previously alluded , this call of nature to change is louder for the bigger the establishment is . Look around what is happening in the world right now .
But to ‘change’ , the first reflex action of human beings is fighting against each other , somehow .
War and peace , of course , is always naturally cyclical .
I am currently witnessing numerous ‘in-house fightings’ within organisations, including GP practices.
Strange but also egregious.
Please keep sending your comments in .From the positive side , this most extraordinary phenomenon of a confrontation between our profession and the government could represent a good opportunity for the ‘change’ I mentioned above.
My view😑😎