One of the issues that has appeared since the Covid-19 Pandemic seems to be that people think that all GPs have gone into hiding. There are many mainstream and social media stories of people being unable to get through on the phones to reception staff or unable to make an appointment with their GP.
What is going on?
Let me explain.
From March 2020 until very recently GPs were working to a national ‘Standard Operating Procedure’. This SOP asked GPs to speak to all patients via phone or video BEFORE bringing them into surgery to be seen. While GPs continued to see those patients face to face where this was necessary, you would have been unable to directly book a face to face appointment. The SOP is no longer in place, but Infection, Prevention and Control Guidance for Covid-19 does still exist. (https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control). Chapter 4 of this guidance states that ‘Triaging…within all health and other care facilities must be undertaken…’, so most GPs have continued with the practice of phone calls first. Additionally, most GPs have found that they can adequately assess, advise and treat many patients using a phone or video consultation without needing to trouble the patient to attend the surgery. This is why you cannot, in most places, directly book a GP surgery appointment like you used to. Please be assured, however, that GPs HAVE been seeing people face to face where needed throughout the pandemic and continue to do so. If you feel you need a face to face consultation then this should be discussed with your GP where you will be able to talk this through with them. It is important to understand that this is not a new, Covid-19 thing. Many GP surgeries were already utilising a phone first triage system as an efficient and effective way of managing increasing demand.
Just because you cannot directly book a face to face appointment does not mean that your doctor is not working or not managing patients.
Numbers of patients being assessed has also increased with more consultations occurring now than before the pandemic. When people are trying to get through to the surgery reception but finding it engaged, or that there is a long queue before the phone is answered, this is not because the reception staff are sat around doing nothing while the phone rings – they are dealing with other patients. Likewise, when you do speak to reception and the next available routine appointment is not for some time, this is because all available appointments are full. There are no less appointments that there used to be – the demand is higher.
Just because you might struggle to get through to reception or book a routine appointment does not mean that you doctor is not working or not managing patients.
Patients being assessed are generally more complicated than before, presenting with multiple problems. The reasons for this are linked to the pandemic. Some people have delayed presenting to the doctor with symptoms throughout the various lockdowns. In some cases this has been because of concern about the risks of catching the coronavirus when attending a health care setting, or because people have not wanting to overload an already busy NHS or even because people have erroneously thought that GP surgeries were closed. Whatever the reason, people are presenting with more advanced illness or disease and with several problems at the same time. This means that GPs are managing greater numbers of patients presenting with greater complexity. This takes more time.
General Practitioners are working harder than ever, not avoiding work.
There have been people criticising GPs and using ‘empty waiting rooms’ as evidence that we are not working. This is not an appropriate indicator of whether or not a GP is working. As you have already read, many consultations are taking place remotely by phone, video or electronic consultation. In addition, please don’t forget that the work of a GP involves far more than consulting with patients. There is a huge amount of administrative work that needs to take place to adequately manage patient care. Every time you have a blood test, those results need to be read and action plans decided upon. Every time you consult with another healthcare provider such as a hospital consultant or if you find yourself in hospital, then correspondence will be set to your GP, which needs to be read. There may be actions for your GP to undertake in those letters. Repeat prescriptions need signing and every day there will be multiple requests for changes to medications for all manner of reasons that will need to be addressed. Remember as well that even pre-pandemic there would have been times when the waiting room was empty. Most practices would operate a morning surgery followed by an afternoon or evening surgery. In between these the GP would undertake home visits and complete the admin described here.
An empty waiting room does not mean that there is no work is taking place.
GPs are not in hiding. Nor are they avoiding work. They have been seeing patients when needed throughout the pandemic, and undertake many patient contacts each day. The number of patients seeking help has increased and the patients being seen are more poorly. The associated administration around patient care has also increased, and all of this takes time.
Please do not think that your GP is sitting with their feet up, or on the golf course. They are not.
There is, however, a problem. People need access to their GP, and many are struggling with this. The pressures on everyone are significant. GPs are NOT to blame for this, but we do need to seek solutions. This is not about GPs working harder, but us all looking to see what we can do to help. The NHS as a whole needs to work together to support patients and GPs in this time of extreme need.
What we really do not need are any more comments or assertions that GPs are not doing their job. You can see from my blogs from last year (link below) that we have been open and working as hard as ever, just not in quite the same way we used to.
Next time you see something in the media or on your go-to social media platform berating GPs for not doing their job, please remember this blog, and perhaps speak up to set the record straight.
Dr Jonathan is a GP in Cheshire