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 email@example.com.