‘Improving access’ to primary care for patients has long been hailed as a worthy aim by the powers that be, most recently enabled in my area through the introduction of digital triage platforms.
My experience of having 24/7 e-consult requests is the complete loss of any fragile boundaries that we had. My clinic used to have a start and end time. Now, the ever-growing screen of patient requests is a like a tap that you can’t turn off. Sometimes it drips, and sometimes it pours.
Any kind of bank holiday causes a flood. Psychologically speaking, I now work with a sense of constant threat – how many more will come? Work is not a safe place, but has become an enemy to defend against.
Improving access for patients has simply increased demand and reduced our capacity to meet it, as resource is needed to process every request. Adding another lane to the motorway just means the cars come faster towards us.
We may be processing more demand, but this isn’t the same as meeting health need. Rather, it gives space for the smallest of health anxieties, after the shortest of time periods for the digitally-savvy.
Perhaps this is a version of the Inverse Care Law? Clearly there is a spectrum of patient requests, many of which absolutely need GP time and care. I’m not wanting to judge what may seem to be ‘health anxieties’ as we continue to experience national health anxiety in the face of pandemic life.
However, I am saying that we in primary care are drowning, and I don’t think I can cope with any more improved access measures. Our sink is simply not big enough.
Dr Eleanor Worthington is a GP in Harrow, London, and clinical director of Harrow CCG Integrated Care Programme