The GP crisis. And why it may prove that the lockdown sceptics had a point.

25 Sep

“We’re still operating under pandemic conditions” is the automatic message I receive when I phone my GP practice. Like many people in the UK, I have been bemused to find out that face to face appointments aren’t available at my surgery, even in spite of the fact that lockdown is over, and the economy has fully reopened.

Data shows that while 80 per cent of GP appointments were conducted face to face before the pandemic, in July only 57 per cent were. And far from the vaccine roll out boosting face-to-face appointments, the opposite trend appears to have happened, with GPs on course to see 80 million fewer people in person this year than in 2019.

Experts such as Professor Karol Sikora, an oncologist, are incredibly worried about the consequences of remote appointments; he tells me that “over my career I’ve probably held over 100,000 face-to-face appointments with patients and you pick up something important every single time. A patient’s body language, visual symptoms and in-person physical examination are all crucial to getting to the crux of the issue.”

The Government is concerned too; in the last few days, Boris Johnson has warned that patients must be allowed to see doctors face-to-face. Ministers will be under no illusions that the UK could be on course for a health crisis much worse than Covid; it is already estimated that 175,000 diagnoses of key conditions were missed last year.

So what exactly is going on with GP practices? Why – with the vaccine here, more PPE and better Covid treatments – are they continuing to operate in pandemic conditions? And how does the Government deal with this matter? 

When I started out this piece, I simply asked the receptionist at my GP why face-to-face appointments aren’t going ahead, and I was intrigued by her response. She had no idea, and responded as though she’d never been posed the question before.

However, reports suggest there are several big reasons for the situation.

First, GPs are feeling overstretched, due to staff shortages, which the Government has been trying to remedy with a recruitment drive. It’s unsurprising that some want to continue with the video/ digital system deployed during the pandemic, so as to get through patients quicker.

Second is that e-consults have not come out of nowhere; Coronavirus, in fact, sped up a move towards digital/phone services that was already under way. E-consults are not necessarily bad in themselves – saving time for digitally-savvy patients in a hurry.

But the main issue is one of accessibility, particularly with those who find technology or staying on the phone difficult. As Dr Ben Spencer, the MP for Runnymede and Weybridge and former psychiatrist, tells me: “Digital exclusion will disproportionately affect the most vulnerable in society”. 

The third, under-reported reason why GP surgeries aren’t fully open is to do with widespread variations in the “physical environment” of practices up and down the country. Some, for instance, are purpose-built, with ventilation and lots of space, meaning that they find it easier to see people compared to smaller surgeries. The latter will be behind the troublesome statistics.

While the Government has issued strong statements about GPs reopening – with Sajid Javid, the Health Secretary, warning that it’s “high time” for them to get back to normal – behind the scenes the Department of Health has taken a softer approach, speaking to NHS England and GP groups about the pressures they face, and how these can be alleviated.

Although the Government has invested £270 million to expand GP practice, improving things isn’t simply about throwing money at the NHS. Bureaucracy, for instance, is something that doctors have complained about; reducing it may be next on Javid’s list.

The Government will also be keen to cool tensions between the public and GPs. Yesterday Javid also held an “emergency” meeting with the BMA GP committee chair to discuss the abuse currently being suffered by GPs, in large part because the media has framed the story as “lazy doctors” against everyone else. In fact, the situation is more complicated than has been presented.

Is this issue going away any time soon? The biggest challenge for the Government is recruiting staff. Although record numbers of people are training to be GPs, it takes years before they can actually practice. No doubt Government critics will use worker shortages to criticise Brexit, and it may come under pressure to recruit from outside the UK.

At the same time, the NHS backlog will increase, and GPs will feel even more reticent to move away from phone/digital services, particularly as flu season arrives. Expect challenging months ahead, which may leave lockdown sceptics feeling vindicated.

After all, they warned that shutting down the economy would prove more dangerous than the immediate threat of the virus. The GP debacle, and the data that’s beginning to emerge from missed appointments, may be the biggest evidence for their argument yet.