DAUK’s GP Team were among the signatories to a letter published in The Observer this weekend, opposing the view that general practice’s problems could be overcome by hiring younger doctors. The letter reads:

Torsten Bell uses US data to claim that when GPs retire, the use of other emergency services rises (“Why baby boomers might end up healthier if their GPs retire early”, Comment). This in itself would be an argument to strengthen primary care in the UK. Bell then claims that new GPs are more likely to pick up a new diagnosis of diseases such as Alzheimer’s, concluding that GPs retiring can be a good thing for patients, while pointing out that it also pushes up the cost of healthcare.

We believe that GP continuity of care not only saves lives and money but also leads to longer life expectancy. The age of your GP is not the problem here. It is the absolute lack of them. The UK is facing a GP crisis that long predates the pandemic. We need to retain our GPs at all stages of their careers – but especially those with many years of experience – who are also best placed to support and mentor junior GPs and the ever-growing number of allied healthcare professionals who are being employed to try to prop up a failing system in the UK.

Contrary to widespread reports, GP surgeries have remained open throughout the Covid-19 pandemic. Official NHS data confirms that more GP appointments are being offered than ever before, and GP teams continue to provide over 90 percent of all NHS consultations. 

Practices were already struggling prior to the pandemic and are now facing near-impossible challenges in the face of a “tsunami of demand”.

Attendees at this briefing heard from frontline GPs who described:

• The causes of rising demand on our services
• The increasing cases of burnout amongst GPs
• The damaging effects of unproven bureaucratic interventions
• Consequences of the demoralising, harmful narratives against our profession
• Proposed solutions to our challenges
• How you can help us help our patients

Nothing happens quickly within the NHS, but it seemed last week that the longest of the health service’s many queues was of patients lining up to complain about their GPs. “It’s impossible to get through to my doctor’s surgery by phone,” says David Wishingsky, a 60-year-old care-home chef from Hastings who is worried about side-effects from his antidepressants.

Megan McGinty, a 19-year-old Glasgow student, developed “horrible” abdominal pain a week ago. “The earliest appointment I could get was October 18,” she said. “It just seemed to me they weren’t even listening to my symptoms or how I felt, just put me on the back burner and told me to wait.”

There are so many stories like this, and so many patients desperate for medical treatment; it is clear that something has broken down in the relationship between Britons and their doctors.

“I understand the system is under immense pressure at the moment, so I don’t like to blame the NHS per se,” says Rhys Harding, 25, who works in digital marketing in Gloucester and has to wait until October 15 for his next chance to talk to his doctor. “But it has been a struggle to see a GP for many years now, and it seems like it’s getting worse.”

Doctors in turn have been horrified to find themselves portrayed as surly fat-cats, raking in six-figure salaries for a reduced working week while steering a wide berth around their patients.

“I hugely resent the idea that I am lazy, workshy and doing my best to wriggle out of seeing patients when, in reality, I’ve never worked harder,” says Dr Elizabeth Croton, a Birmingham-based GP and committee member at the Doctors’ Association UK. Nor can the crisis be wholly blamed on the after-effects of Covid-19.

“The NHS is at a watershed moment,” claims Dr Simon Hodes, 49, who has worked as a GP in the same Watford practice for 20 years. “GP teams cannot be everything to everyone and our resources are finite. There is clearly a mismatch between supply and demand.”

The number of patients per practice is now 24 per cent higher than in 2015. In these circumstances, it is not surprising appointments are hard to come by. “Of course I can understand people’s frustrations about remote consultations,” Croton says. “I struggle daily with a hollow feeling of not having the resources to do my job properly.”

The roots of the current GP crisis stretch back almost 20 years to the 2004 decision by John Reid, the Labour health secretary, to allow GPs to opt out of 24-hour responsibility for their patients.

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It’s 8am and I’m already sitting in front of my computer at the surgery.

I prescribe myself some coffee and scroll through the blood results and hospital letters that have accumulated since yesterday. There are at least one hundred of them in total. 

I get through as many as I can before I see my first patient at 8.30am. I have a minimum of 32 contacts a day – as many as half of these are seen in person, depending on the nature of their issue.

Abdominal pains and earaches are easier to see in person, whereas a contraceptive pill request can often be dealt with over the phone. 

Working as a General Practitioner has always been both an art and a science to me. I have my clinical guidelines to advise me what drugs and investigations are suggested for each patient’s presentation.

But people are complex and one has to know how to tailor the science to the personality of the patient. This can take years of practice. 

I’ve been saddened by recent negative press articles, complaining about the service that GPs provide. I hugely resent the idea that I am lazy, work-shy and doing my best to wriggle out of seeing patients when, in reality, I’ve never worked harder. 

Virtual appointments were essential as the pandemic hit: people who were shielding and potentially infectious were kept away from each other. I saw those I couldn’t manage over the phone in person, but there was always the concern of contracting Covid.

I remember some seriously ill patients who didn’t want to attend hospital. One doctors’ surgery springs to mind where 50% of the patients had that characteristic dry cough that I will always associate with this virus.

Of course, I can understand peoples’ frustrations about remote consultations. As a clinician, I also find them difficult at times and I often work a lot faster and more effectively if I have the person in front of me. 

However, it’s not that simple in an ongoing pandemic. Many of the Covid cases I have seen recently have had relatively mild symptoms, reminiscent of a cold. It would be very easy to bring them in to sit in a waiting room with a vulnerable patient (which, clearly, would best be avoided) – so, virtual consultations eliminate the risk of this happening.

I think there has been a public perception that our services have been closed, which has not been my experience

However, some of our patients do welcome virtual consultations. I was talking to a lady today who loves the fact she doesn’t have to drag the kids in with her and entertain them in the waiting room. 

We have a lot of university students who enjoy the fact that they can take a call from the gym or the library.

That said, they will never be appropriate for everyone and we need to find a balance and consider the needs of those who don’t have access to a smartphone, for example.

With something as complex as the NHS, it’s unhelpful to scapegoat GPs, blaming them for reorganising their services to provide care in unprecedented times.

I think there is a public perception that our services have been closed, which hasn’t been my experience. Our GP services are something we all require access to throughout the course of our lives and we’re all likely to be patients at some point, therefore all parties must all work together to craft a service that meets the needs of the population it serves. 

While, as GPs, we work as hard as we possibly can, there are lots of things that need improvement. Personally, I’d like to see the flexibility of longer appointments for patients who need more time. I’d also like to see more investment in the service to allow greater continuity of care for patients with the same GP. 

I struggle daily with a hollow feeling of not having the resources to do my job properly, particularly in the fields of mental health where patients are often told that they are ‘not sick enough’ to qualify for the specialised help that they need. 

For a patient who has never spoken about the despair of depression to another human being, 12 minutes is a pitiful amount of time – but that’s generally the length allocated to each person waiting. Sometimes it can take that long to utter a sentence for a patient experiencing profound social anxiety. 

I’m often asked if I have ever thought of quitting. Honestly? Long hours and decision fatigue have made the thought cross my mind at times but I don’t think that I could or would walk away.

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