As a former GP principal, I am all too aware of the challenges GP practices face meeting patient demand for care. Adding to this, practices have been forced to rethink how they deliver care during the Covid-19 pandemic. There has been a drive to innovative ways of working, including increased use of telephone triage, email encounters and digital video consultations. This is appropriate for many encounters and shows that general practice is evolving to the needs of patients. Practices and primary care networks have also adapted protocols and systems to provide safe face-to-face care and there are many good examples of this.
However, in my role as an out-of-hours GP, I continue to encounter patients who report that their practice is closed or that phones are not answered when they try to call. On other occasions when patients manage to speak to their practice, they are advised to contact 111 for a face-to-face review.
Discussions with colleagues working in urgent care and casualty departments reveal that they also have encountered this. As a consequence, far more patients are being seen in settings where they are not best managed. These patients need either ongoing care from a GP or specific referrals which are not done in the out of hours or emergency setting. This results in a delay in care that has the potential to compromise patient well being including worsening of chronic mental health problems and delayed suspected cancer referrals.
I recall seeing a 65-year-old patient with rectal bleeding who his GP managed on the telephone initially as suffering from haemorrhoids, then on a subsequent occasion when the bleeding persisted was told to call 111. When I examined him , I felt a rectal mass. The patient journey would have been more agreeable and safer if his GP had seen and examined him in the first place. This would have happened last year and I would argue should continue to happen.
There is also an opportunity cost – the time out-of-hours providers and hospital spend dealing with these patients could have been more effectively spent managing patients with more acute problems, including Covid.
I appreciate that we are working in unprecedented times. Things have not been helped by the fact that general practice seems to have been overlooked by the Government in delivering the response to the pandemic. I feel we could have been asked to play a far more active role in local Covid management, which is a shame. Additionally, as if often the case in general practice, there is great variation between practices and networks. I would argue that there will be no better time than present for greater collaboration and shared learning.
Finally, I hope that my colleague do not mind if I ask them to consider that if I can see patients, why can’t they?
Dr Milan Dagli is an out-of-hours GP in Middlesex