Recently, GPs reacted with fury to the ‘advice’ from NHS England that we should be offering face-to-face appointments.
In light of *that letter*, discussions circulated around whether its director of primary care, Dr Nikki Kanani, should resign. In my view, there are ample grounds for her resignation, but not necessarily attributable to this particular letter. Yes, it was an insult to hardworking GPs up and down the country; yes, it was released for political purposes to redirect the public’s ire at lockdown restrictions and our buckling health service.
Still, I don’t believe that medical services are ideally delivered remotely. I worry about our diagnosis of new cancers, without essential opportunities to examine patients. I worry that we’ll be missing new hypertensives, patients in atrial fibrillation, and countless other diagnoses that are only made after physically seeing a patient. I worry that remote consultations inadvertently divert care away from the frailest and sickest, towards younger groups who tend to be more tech-literate.
So, yes, perhaps there was truth at the heart of the letter – we do need to find a way to make face-to-face appointments more accessible to the right patients. But couldn’t NHS England have used a carrot rather than a stick? If the evidence suggests that increasing face-to-face appointments would significantly improve public health, GPs could have been offered targets to work towards, with financial incentives. Those practices unable to meet these targets should have been offered support, not abuse. GPs have worked incredibly hard (out of necessity) to redesign their services, often at great personal cost, and deserve recognition for the toll that the past year has taken.
Rather, the grounds on which I’d call for Dr Kanani’s resignation stem from the fact that she’s been medical director for primary care for over two years, and no meaningful action has been taken to deal with the unfolding crisis in general practice. Where is the urgent taskforce to review our workload? Where are the ongoing funds to allow practices to employ locums, or offer extra sessions to GPs, to stem the growing gap between demand and GP provision? The ARRS has made precious little difference to the working lives of GPs, who continue to flounder under an unmanageable workload. PCNs are proving barely more than a vanity project, and show few signs of improving care provided to patients. GPs need increased core funding, interventions to control our workload, and action to bolster our numbers. Dr Kanani has had ample time to institute such changes, and she has failed to.
Take the countless mindless administrative tasks that we GPs become embroiled in. For example, I recently spent 40 minutes with a non-English speaking refugee, using a translator, explaining the complexities of a referral for fertility treatment. The need for a second semen sample from her husband, how and where to provide this, how to arrange blood tests on the appropriate days, the requirement for proof of MMR vaccination… Why, oh why, do we not have access to a service where we can directly signpost patients for their fertility investigations? These administrative complexities are replicated throughout my day, from the hoop-jumping in managing abnormal liver function tests, to navigating the referral processes to allied services – for example, to access a speech and language review or continence assessment might take 15 minutes, such is the complex web of history and examination that are required.
How have we allowed so much of the burden of secondary care work, or allied healthcare services, to be laid at our door? It’s crippling our ability to manage patients who desperately need medical advice.
We urgently need a taskforce of frontline GPs to examine our workload, so unnecessary burdens can be removed from us. We need leaders who will engage with the crisis that’s unfolding, and take action. Not next month, or next year. But now. General practice is on its way to collapse, and when it does it will bring down the rest of the NHS with it.
Dr Kanani has many commendable attributes, and I’m sure that she’s an excellent GP. Sadly, however, it’s becoming clear that she lacks the characteristics to bring about the reforms needed to sustain our service. Somebody new needs to take up the baton.
Dr Katie Musgrave is a newly-qualified GP in Devon and quality improvement fellow for the South West