This site is intended for health professionals only

Let’s not pretend the NHS is open for business

The NHS is closed for normal business. Don’t let anyone tell you otherwise. Having written about the situation denying curative surgery to cancer patients (among other things) just three months ago, I find myself sitting and saying: ‘I told you so’. And I don’t relish in that statement.

I was frustrated back then and met cries of: ‘No, its not true, we’re doing cancer in the private sector’. And yes, a little bit of cancer was initially sorted in the private sector and now more routine stuff is being done.

But – and it’s a big but – what about other stuff? Some routine, some not so routine. What’s happening to that? Well, as a GP trying to get people seen, I can tell you… very little indeed. And today, just like every other day at the moment, it was sad and I left work really feeling for the patients to whom I said repeatedly: ‘I’m sorry but I can’t organise that at the moment’. I feel like an admin assistant telling the customer that the computer said no. I didn’t study medicine to be that person.

Today, as with so many days as a GP since Covid raised its ugly head, I am that person. And it’s so hard to explain why ‘routine’ for the NHS is so far from routine for the patient.

Imagine you were at home recovering from cancer – the surgery, the chemo, the diagnosis itself, and to make it just that much worse, you also have to stay away from all other humans because you’re just too vulnerable should they pass Covid to you. Then your hearing gradually vanishes, you know it’s wax because it’s happened many times before, but this time the effect is even more devastating because your hearing is the only thing allowing you access to your friends and family, to normality. But when you phone me to organise a simple sanity-saving procedure, I say sorry (well, I shout it): no, not at the moment. Imagine being so distressed by this news that you call 111 for help, and they tell you to speak to your GP.

Patient by patient, they’re critical for some

Imagine you have dementia. That your GP knows you well and has worked to get you seen and treated at the memory clinic, but she has recognised that things seem to be worsening. She refers you back to the memory clinic. They do a telephone appointment and agree with your GP and write to them. They say in the faceless letter that they’ve discharged you from services as point one and for point two, asks your battle-weary GP to refer back for face-to-face assessment and commencement of a new drug that may help things slow a little, when services reopen. Not only is this a wicked waste of yours and your GP’s time, but the clinic have no idea of when that might be, and they tell your GP that they can’t start the medication.

Imagine you have slowly deteriorating hearing, making everything difficult, but not impossible. But because you’re reading the papers, you’re aware enough of the tsunami of referrals to come to GPs, that you think you’ll get in early because actually, while being almost deaf is not impossible for you personally to deal with, it’s really hard. So you want to ask to ask your GP if they can do the referral for a hearing test today, so you’re at least in the pile when things get going again. Imagine you’re that totally reasonable patient downplaying their symptoms.

The list is endless. There are patients desperate for scans or X-rays which aren’t ‘urgent’ if we’re talking red flag urgent, but are important in terms of management and giving us a clue as to what we’re dealing with. They are of course urgent for the patient. The fertility referrals which take eons anyway, but at the moment I can’t even get a semen sample done, which is needed for any referral. The ring pessary changes which are well overdue and causing distress, but are deemed non-urgent. Who is deciding that these things aren’t important? I get that they sound trivial on paper, but in context, patient by patient, they’re critical for some.

And so I sit and apologise for the computer saying no. It’s sad and it’s frustrating, but above all, it’s wrong. I hear stories of staff sitting in clinics with no patients. We’re sending texts telling people that they must come forward if they have an issue. The media is selling a tale of ‘The NHS is open, please don’t delay if you need us’. But it isn’t, and someone who can change things needs to know… the NHS is closed for routine stuff and I’m, as always, the merchant of doom at the gate (or true frontline).

Dr Renée Hoenderkamp is a GP in North London