Around 1,600 GPs and hundreds of other signatories have backed a complaint to the press standards watchdog by the Doctors Association UK (DAUK) over Telegraph articles on access to general practice.

In a letter to the Independent Press Standards Organisation (IPSO), DAUK chair Dr Jenny Vaughan said negative coverage risked ‘eroding public trust’ in primary care services and that this could represent a serious ‘patient safety issue’.

More than 2,500 people have signed an online petition in support of the complaint, which questions the accuracy and potential impact of two articles in the Telegraph.

One of the articles was headlined ‘GPs are improving their work-life balance while worsening the life-death balance of everyone else’, and the other ‘Time to turn the heat up on GPs who won’t see us face-to-face‘.ADVERTISING

GP access

The articles have also drawn criticism from the RCGP and the BMA, with college chair Professor Martin Marshall last week speaking out to defend GPs’ response during the pandemic and warning that growing levels of criticism and abuse were undermining doctors’ mental health.

Tne DAUK complaint letter, which asks for a formal response and an apology, says: ‘GPs are doing their best to help patients within a broken system during unprecedented times. We are extremely disappointed by the lack of central and governmental support, and we agree that our patients deserve more from our NHS.’

The letter points out that ‘83% of our patients report a “good GP experience” during the pandemic’ and that GPs want this to be even higher – but warns that ‘attacks’ on the profession in the media ‘make it hard for us to succeed’.

The DAUK letter warns that suggesting GPs are refusing to see patients face-to-face could stop patients seeking help for serious symptoms, or mean they present to emergency departments.

Patient safety

A DAUK spokesperson said: ‘The narrative that general practice has been closed throughout the pandemic has filtered down to patients. This needs to be called out.’

Last month, BMA GP committee chair Dr Richard Vautrey responded to Telegraph coverage of GP access, warning: ‘Many of the family doctors I represent are at the end of their tether, and such constant undermining and chastising will push them further towards the door, leaving us with even fewer GPs and making it even more difficult for patients to get the treatment they need.’

A recent survey by the MDU revealed that four in five GPs say abuse from patients has worsened during the COVID-19 pandemic, with delayed treatment and high demand for appointments fuelling frustration.

The Telegraph was approached for comment.

Read the full article here.

The role played by international staff in the NHS received widespread media coverage recently after current head of NHS Test and Trace Baroness Dido Harding said she wanted to make the NHS less reliant on foreign doctors and nurses if she became the next head of NHS England.

As a ‘foreign’ doctor myself, comments like this sadly echo the racist statements we are increasingly hearing from patients. These include things like: ‘I want to be seen by a white doctor’ or ‘Why don’t you go back to where you came from’.

At a time when abuse towards NHS staff is becoming the norm, and all areas of the service, especially primary care, face overwhelming demand, we need the next leader of the NHS to understand that the NHS relies on its workforce to function.

International staff

Almost 200 different nationalities are represented within the NHS in England. The majority of staff are British, but as of January 2020, 169,000 (13.8%) report a non-British nationality, with Indian, Filipino and Irish representing the highest numbers. Some 67,000 members of staff are nationals of other EU countries.

Despite being the biggest employer in the UK, the NHS doesn’t have enough staff to meet demand. According to recent data from NHS Digital, the NHS has a shortfall of 84,000 FTE staff, and this does not include primary care where we know there is a shortage of GPs, and is before absence figures for COVID-19 are factored in.

Since its inception in 1948, the NHS has been heavily dependent on overseas healthcare workers, demonstrating that ‘foreigners’ are not only important, but vital for the smooth functioning of NHS services.

COVID-19 pandemic

This is even more apparent as we emerge from the challenges of the last 18 months, where international healthcare workers have stood shoulder to shoulder with their British colleagues.

Last month, former health secretary Matt Hancock told the parliamentary inquiry into COVID-19 that 1,500 health and social care workers have died during the pandemic and we know that with those from a Black, Asian or ethnic minority background are at an increased risk.

‘Foreigner’ comments make international healthcare workers sound like a burden on the NHS and completely undermine their contributions. Not only do they offer their skills and experience as healthcare workers, but they pay the same amount of tax as any British worker without having any recourse to public funds.

After residing in the country for 5-6 years, they then have to pay over £2,000 to apply for Indefinite Leave to Remain. They are also frequently seen investing in property, shares and tourism.

In 2015, the coalition government introduced the Immigration Health Surcharge (IHS), an annual fee of £624 that migrants need to pay to use the NHS. For a family of four, this charge, along with visa fees can easily reach £10,000 a year – which for tax paying NHS staff is an extortionate amount of money to pay in order to access the very system they work within.

In October last year, after lobbying by the DAUK, the Prime Minister announced that international health and care staff and their dependents would be exempt from the IHS, in view of their efforts during the pandemic.

It is time we valued our migrant healthcare staff, which is why DAUK will be supporting the bill to grant indefinite leave to remain to overseas staff, like myself, who have given their all to the NHS during the pandemic.

The NHS relies on the goodwill of its workforce to stay afloat, and the next leader of the NHS, whoever that is, needs to take this onboard

• Dr Pushpo Hossain is junior clinical fellow, acute medicine and a committee member of the Doctors’ Association UK (DAUK)
• Read the article in full here

Lockdown is easing, but as everyone lets out a cautious sigh of relief that normality may be around the corner, GPs are dealing with a tidal wave of work which shows no signs of abating.

When the pandemic descended last March, NHS England mandated the move to ‘total triage’ in primary care to protect patients and staff from COVID-19. We transformed our services overnight, moving our 1m consultations a day to remote telephone, video and online consultations, while localities shared staff and resources to set up hot hubs to see anyone with a clinical need.

Busier than ever

Data from NHS Digital showed, contrary to the reports of being ‘closed’, general practice was busier than ever. Not only busier, but dealing with more complexity and carrying the increased risks of remote consulting.

Every part of the health service has felt the strain of the pandemic. Secondary care deployed staff and cancelled routine work to funnel the majority of their resources into critical COVID patients. General practice held the fort for everything else (before even mentioning the millions of people we vaccinated). Waiting lists have spiraled and we in general practice are feeling the impact.

Patients waiting longer for operations need more GP appointments to manage their unresolved symptoms. We titrate up pain medications in one consultation, only to then treat the side-effects of those medicines the next. Those waiting for investigations have longer to worry about what might be wrong, or to re-present with deteriorating symptoms.

Meanwhile, patients who have stayed away throughout the second wave are starting to reappear. Many have been sitting on worrying symptoms for far longer than usual. People are sicker, there is more pathology, and even when the problem itself is straightforward, health anxiety is rife.

The mental health fall-out from the pandemic is only just beginning. Bereavements, job losses, financial strain, families imploding under the pressure of lockdown, people daunted at the prospect of rebuilding everything from scratch in a world where everything is more difficult than it used to be.

The impact of remote access

Remote access has made us paradoxically both more and less accessible. Online consultation systems allow busy people, who would never take time out of their day to come to the surgery, to contact us more often, about problems they previously would have ignored or dealt with themselves.

E-consults submitted when anxiety strikes at 3am about a self-limiting symptom, seem essential at the time, but more often than not, have resolved when the GP makes contact within the 48-hour timescale. The time spent reading the notes, excluding red flags, and then often dealing with a list of ‘while I’ve got you doctor…’ means GPs are working harder than ever ‘not seeing’ people, leaving the hard of hearing and less technologically able struggling to access care.

Healthwatch’s recent report confirmed that patients do feel they are unable to access a GP, with 75% of respondents reporting negative experiences. Over a year into this crisis, there remains a widespread belief, perpetuated by some parts of the media that GPs are closed. Changing this mindset may prove impossible.

Colleagues report conversations with patients they are in the process of seeing face to face, in their surgery who ask mid examination ‘When are you going to re-open doctor?’. People who have had multiple remote contacts with resolution of their problem also remain dissatisfied – clearly there is a therapeutic value of looking their doctor in the eye.

What is the solution?

The Doctors’ Association UK has asked NHS leaders to take note and urgently review this crisis in primary care – which is a reflection of the state of the NHS as a whole. But what is the solution?

Throwing more money at primary care is only going to work if we have the right people in place to enable it to function. The NHS continues to haemorrhage experienced staff – due to burnout, retirement, alternate careers and more accommodating health systems overseas.

Ivy Grove Surgery in Derbyshire spoke out last week, with a 16-page open letter to patients outlining why demand is so high right now. Many found their honesty unpalatable and patient-blaming but their words undeniably resonated with frontline GPs, and the points they raised need to be brought to the table when discussing how we improve this situation.

Perhaps the answer lies in our individuality as GPs. Access arrangements to general practice have never been more uniform, nor more uniformly unsatisfactory to both patients and staff. What works for one patient population is completely unworkable for another.

Give us back the freedom to limit the e-access and decide what will work for our own unique mix of patients. The risk-benefit balance of a walk in and wait surgery will look very different in a rural community to how it would look in the centre of London. We need to be able to make those choices based on our expert knowledge of our communities, and it is time for us to start putting that expertise back into action.

Read the Opinion piece in GP Online here