Just yesterday in surgery I saw patients face to face. In each case, it just wouldn’t have been appropriate to care for the patient remotely. I listened, examined, arranged tests if needed and described the next steps in reaching a diagnosis. I spoke with patients and their relatives, some of whom were worried. I made sure that they felt properly heard. They needed the kind of reassurance that you can only achieve when in the same room together. In the same surgery I saw a young woman who was presenting for the third time with a suspected infection. She had been prescribed treatment remotely on two occasions, but when she presented for a third time I asked her to come into the surgery so I could examine her and carry out a swab. While she was initially keen to be seen remotely, as a clinician I’m acutely aware of the importance of raising the ante when treatment isn’t working. She understood why she was being asked to come into surgery and was keen to do so—we worked together, it was a joint decision.
Throughout the covid pandemic, like all GPs I’ve done my best to work with my patients to ensure that the care they receive meets their expectations, albeit altered ones because of the crisis. Together, patients and I are tackling the challenges of social distancing, and I believe stronger GP-patient relationships are being formed as a result.
These examples have been replicated by GPs across the country in recent months. It’s fair to say that throughout the pandemic GPs and our teams have worked hard to do the right thing under difficult circumstances. We’ve done all we can to ensure our patients receive the care they need. At the peak of the virus, hospitals came very close to becoming overwhelmed, but they didn’t. A significant factor in that was the work that GPs and our teams did at the community level. General practice’s response to covid has been remarkable. It’s something the profession should be proud of. GPs and our teams have gone above and beyond, knowing full well that we have a difficult winter ahead with challenges none of us have ever experienced before.
Now is not the time to demoralise the profession—and this is what NHS England’s recent letter to GPs achieved. It is time to thank GPs for what they are doing and prepare and support them for what’s to come.
Both GPs and patients alike must have clear, consistent messages from government. Conflicting advice will confuse and frustrate. In July, health secretary Matt Hancock called for all consultations in general practice to be “remote by default”—a concept the College has opposed and a message which is out of sync with the headlines we saw on Monday, berating GPs for following official guidance. This mixed messaging is counterproductive and unhelpful.
As both Chair of the Royal College of GPs and a practising GP in East London, I don’t want to see a completely, or even mostly, remote general practice service long-term. It runs the risk of further increasing health inequalities, and it’s neither suitable or preferable for many patients. But the predominantly remote service that general practice has been operating under over the past few months is an appropriate response to a pandemic, in line with NHS England’s advice to slow the spread of the virus. GPs haven’t chosen to work in this way, indeed many are keen to be able to see more patients face to face again.
Data from the RCGP’s Research Surveillance Centre tells us that while there was a fall in demand for routine appointments at the peak of the pandemic, demand is now back to near normal levels—levels that pre-pandemic most GPs regarded as “undoable.” The data also show that 30% of consultations—over 300,000—are being delivered face to face by practices across the country every day. Add the responsibility of delivering an expanded and complicated flu vaccination programmes. Add typical winter pressures. Add dealing with the aftermath of the first wave of the pandemic, caring for patients with long covid, and other indirect consequences of the virus. Add preparing for a potential second wave. The next few months are going to be tough in general practice.
The RCGP wants to work constructively with NHS England and others to ensure GPs and our teams are supported for this, and looking past the pandemic, to ensure that the GP workforce has the capacity and resources to handle demand in a post-covid society.
Martin Marshall, chair of the Royal College of GPs and a GP in East London. Twitter @MarshallProf
Competing interests: No interests to declare.