General practice is in under extreme pressure and is dealing with unprecedented volumes of work and abuse.
General practice remains the bedrock of the NHS as an effective, cost efficient health service. Ninety per cent of healthcare starts and finishes in general practice. Prior to the pandemic general practice had significantly declined due to decades of underinvestment.
During the pandemic general practices rapidly changed how we delivered services, in line with the guidance provide by NHS England, to keep patients, their family and carers, and our staff safe, whilst continuing to provide a service without ever pausing.
During the past year practices have seen a significant increase in workload. Recent figures show that in March 20211 general practices in England provided over 28.5million appointments. This was 5 million more appointments than in February 2021, and 2.3 million more appointments than pre-pandemic times in March 2019. This is at a time when there has been an ongoing significant decrease in the number of GPs and practices. The number of GP partners in England has fallen by 22 %3. The number of practices also continues to fall. 98 practices closed last year, meaning 263 thousand patients had to find a new practice. This has been mainly due to financial instability and inability to recruit new GPs and nurses to replace those retiring or choosing to leave.
On top of trying to cope with this increase in demand and reduction in resources, general practice has been the core of the highly successful Covid Vaccination Programme, delivering the majority of doses. During the pandemic general practices have been falsely accused of not pulling their weight and being ‘closed for business.’ As you can see the truth is far from this.
But constant negative comments have resulted in more patients complaining about their practices and our colleagues and staff being demoralised. When hospitals had to close whole departments, general practices were left to support those patients with complex chronic conditions. The huge backlog means that general practice will remain busy for the foreseeable future. As hospital departments restart their outpatient clinics these are often done remotely, and they frequently expect general practice to pick up their work (for example arranging blood tests and scans, prescribing medication, arranging follow up, issuing sick notes) in addition to our own workload. This further reduces general practices’ ability to help our patients.
The ever-increasing workload, false negative comments, and underinvestment is having a significant effect on our colleagues with 20% more GPs presenting to mental health services during the pandemic compared with the year before.5 The BMA report that over a third of GPs are considering early retirement in the next 12 months and 22% are planning to leave the NHS6.
In all the time I have worked for the NHS, we have never ever encountered the level of vitriol that has been levelled at us in the past few weeks. We have all noticed not only huge increases in patient demand, but also massive increases in complaints.
“Perhaps most distressing of all is a real surge in the number of patients who feel it is appropriate to shout at, swear at and insult not just our non-clinical staff but clinical staff as well. We have at least one member of staff reduced to tears every single day.”
NHS figures released this month show that GP practices in England delivered almost 5m more appointments in March 2021 than the month before, and nearly 3m more than in March 2019.
The Institute of General Practice Management (IGPM), which represents staff across the UK, carried out the poll. It has launched a campaign video on YouTube calling for a zero tolerance approach called “If I die, it will be your fault” – after one of the most common abusive statements directed at staff.
The BMA’s GP committee chair, Dr Richard Vautrey, said it was very concerning to hear of the rising levels of abuse and aggression being experienced. “There can never be an excuse for this kind of behaviour,” he said. “Unfortunately, GPs and practice staff are very often at the receiving end of this frustration, when really it has originated as a result of many issues outside the control of the practice, such as lack of resourcing, chronic understaffing and years of underinvestment by the government.”
Prof Martin Marshall, chair of the Royal College of General Practitioners council, said the supply of doctors was not enough to meet demand: “This was already the case before the pandemic, and we are now at crisis point. We are hearing from our receptionists and practice staff that they are bearing the brunt of this frustration, and even anger, and this is having a serious impact on their wellbeing and morale.”
So what are we asking you, our patients, to do?
Be respectful and kind. Please respect that general practitioners and our staff are working harder than ever to provide healthcare. Being abusive and rude will not get you seen quicker or improve your outcome.
Be self-sufficient. If you or your child have a minor rash, signs of a cold, or other minor symptoms, do not think GP first. Try home remedies, look for advice from www.nhs.uk, or ask for help from a pharmacist. Only seek an appointment if you have serious symptoms, or advised to by a pharmacist.
Be prepared. Keep simple remedies including paracetamol or ibuprofen at home. Order your repeat medications well in advance. Think about signing up to the NHS App or other App provided through your practice.
Be thoughtful. Practices are receiving a massive increase in complaints. Each complaint takes staff away from patient care to respond to. Before complaining, think whether it is appropriate. Is it due to an error or mistake which practices should know about to change or improve their services, or is it relating to the significant reduction in the current capacity to provide services by practices or hospitals and therefore no change is possible?
Be Covid aware. If you develop a new cough, high temperature or loss of taste or smell, it could be Covid. Do not contact your GP unless you have done a Covid test first. Do not attend at the surgery, as this could cause an outbreak, infect vulnerable patients or staff, and lead to the practice having to close all their services for a deep clean.
Be patient. All health services have been significantly affected by the pandemic with huge backlogs. Your GP cannot change this. Do not expect your GP to get an appointment or investigation brought forward unless there has been a significant change in your condition. You can only be moved up the list by making another patient wait longer.
Be cancer aware. We are concerned that the number of patients presenting with symptoms of possible cancer or other significant illnesses has reduced during the pandemic. If you or someone you know have worrying symptoms, then please do not delay but make an appointment as soon as possible.
We send our sincere sympathies to everyone who has been affected by the pandemic. GPs and our staff have also been affected. Too many of our colleagues, family members, friends and patients who we have known for many years, have died or otherwise suffered.
We hope that this letter has helped to explain the pressures that general practice is under, why we cannot provide the level of service that you would like to receive, and practices would like to provide. Please consider how you can help to protect services and ensure they are targeted towards patients with the greatest need.