It’s set to be a challenging winter. Look around, and you will realise that every circumstance is against us. The nation spent three or four months studiously avoiding their GPs, while routine surgery and outpatient appointments were cancelled across the land. The public have been locked in their homes, and lost crucial avenues of social, physical, and emotional support. And there is the mysterious illness, named Covid-19 (although this seems to have barely reached us in deep, dark Devon and frankly is the least of my concerns right now).
What is concerning me, however, is the wave of unmet need arriving at the doors of general practice; just at the time that we tend to get busy with winter viruses, flu vaccinations, and QOF targets.
The coronavirus has shone a light, if nothing else, into what happens when you underfund and understaff a service for decades. Public health, general practice and acute trusts have all been victims of years of underinvestment. As a nation we have tolerated a sub-standard health service for far too long. And we wonder why the UK is faring so poorly in its management of the pandemic?
I refuse to perpetuate the myth that the big, bad coronavirus has struck us unawares, and there was nothing that we could have done. There absolutely was action we could have taken. We should have taken it ten years earlier, and invested in better health care structures. Why, I wonder is Germany coping so much better? It is, I would argue, nothing whatsoever about having a better strategy or taking a different approach.
Lockdown or no lockdown, decent test and trace or not. Well-resourced, well-staffed health and public health structures were always going to cope better when greater stresses were placed upon them. And with an ageing population, we knew the demands were increasing, not to mention the natural fluctuation which is bound to occur within any system.
I’m all set to hang my head in despair, say it’s too late and give up now (one way ticket to Oz or New Zealand, anyone?). But the thing is, I genuinely believe it isn’t too late. As GPs we are in the privileged position that we can effectively campaign for change within the NHS. Take, for example, the additional roles reimbursement fund held by CCGs around the country. At the last count, there were £24 million in unspent funds, ring-fenced for additional roles, such as health coaches and podiatrists.
But we don’t need them, I hear you cry? No. We do not. We desperately need these funds to employ doctors, nurses, and phlebotomists to take on extra sessions. Many part time GPs (more than 60%, in fact) when surveyed say they would take on extra sessions if their workload was better managed. There are unemployed locum GPs sitting at home waiting for the call. We have the workforce, we just need the funding.
We all know that when there are not enough of us – as is abundantly clear right now – patients suffer. Palliative patients are poorly managed, struggling with pain because their GP can’t visit. Mentally unwell patients are not listened to, feeling dismissed and disregarded. Cancer diagnoses are missed, as we haven’t the time to bring everyone in, and there are too many calls to attend to. All the harms, small and large, add up. They contribute to national mortality figures; and as well as the premature deaths, there is avoidable suffering along the way; not to mention more pressure on secondary care services. Additional pressure on the hospitals in turn leads to more deaths and suffering. A tragic cycle of failure.
It would be a national scandal if, in the midst of this health crisis, NHS England remained so wedded to their ideology of multi-disciplinary teams; that they refused to release the primary care funds they have, to allow GPs to see their patients. We are remarkably efficient, well-trained, and would desperately like to provide a better service.
So, I challenge you to write to your MP today. Ask for these funds to be released to general practice, and be earmarked for a coronavirus pressures fund. You could copy the text of this blog, if helpful. Let them know that many, many avoidable harms and deaths (which will result from the present inadequate provision of primary care) could be subverted. The outcome of this pandemic truly could be wildly different, if only GPs were given adequate support to provide a better service. Save us, NHS England. We want to help our patients, but we need your help to do so.
Dr Katie Musgrave is a newly-qualified GP in Plymouth and quality improvement fellow for the South West