Abuse against doctors must not be tolerated

Last week a letter signed by 435 GP practice staff on access to GP practices was published in The Times. The letter was drafted by a group of grass root GPs, in response to the recent misleading allegations that GPs have been “closed” during the pandemic. These headlines damage the reputation and morale of the workforce. Responsible media reporting is a patient safety issue, as those patients who believe this false rhetoric may not seek help for worrying symptoms. We have already seen reduced rates of cancer diagnosis during the pandemic by around 40%, along with reduced presentations of other major non-covid illnesses. Irresponsible media may also cause inappropriate use of emergency departments and the NHS 111 helpline, which adds further pressure on our secondary care colleagues at a critical time for the NHS.

In September, NHS England wrote to all GPs statingIt is important that no practice suggests in their communication that the practice is closed or that the practice is not offering the option of face-to-face appointments.” This letter was clearly a well-intentioned warning/reminder to the small minority of practices who have avoided face to face contacts, or who are difficult for patients to access. Fair and equal access is an issue that needs tackling, with poor examples bringing disrepute to the entire profession, and helping fuel hostile media reports. It is no surprise that GP practices have reduced face-to-face appointments given that the entire NHS (and country) has been advised to work from home and use digital technology where possible to improve infection control and protect society. However, this does not mean that GPs are not available to their patients. 

The current backlash against primary care staff feels relentless. We are reading headlines saying we are “closed,” yet we are working harder than ever before. We have been setting up and running community covid hot sites, facing staff shortages due to self-isolation, dealing with a backlog of work from the first lockdown in March, helping patients manage the effects of long covid, delivering an expanded flu vaccination campaign (with covid vaccine on the horizon) and maintaining a “normal” service throughout with no extra funding. In addition, we are trying to integrate into primary care networks, while still unbelievably being asked to continue all normal performance related targets (eg QOF), which confer little patient benefit and detract busy GP teams from our priority—fair and equal access to safe care.

There is a sense from primary care staff that secondary care work is being passed back to us from “virtual clinic” letters, with lists of requests and follow up actions which we would normally expect the hospital teams to organise themselves. At the same time, we hear regular reports from emergency departments reporting increased workloads as “GPs are refusing to see their own patients.

The covid-19 pandemic has brought sweeping changes to healthcare probably more than any other sector of society.  Matt Hancock has repeatedly referred to general practice as “The bedrock of the NHS, and many would agree. Primary care deals with 90% of all NHS contacts, on around 10% of the overall budget, and delivers over 300 million consultations per year (compared with 23 million emergency department visits). So clearly any small shift of patients out of primary care, due to reduced access, can have an amplified ripple effect on secondary care, walk in centres, NHS111, emergency departments, and out of hours GPs. Hospitals were told to cancel all routine care and outpatient clinics to free up capacity, and this seems to have been widely accepted. Whereas GPs have come under considerable criticism. 

When covid struck the UK in March 2020, primary care, like the rest of the NHS, was told to go digital first to limit the spread of infection. We had to independently plan and implement a variety of strategies for providing virtual patient care alongside face to face consults including secure video platforms, photo uploads and eConsultations (web enquiry forms). UK Government messages initially advised patients to avoid using their GP and to use NHS111. Testing for covid-19 was outsourced to private providers. Rather than utilise and strengthen primary care, we have been bypassed. 

The move to digital consultations works well for most patients, but there are down sides, and many GPs are concerned about “digital exclusion” which may once again further widen health inequalities. Many primary care staff find virtual consultations more tiring interactions and perceive increased clinical risk. Virtual consulting reduces non-verbal communication, human interactions are reduced, and the chances of picking up other incidental diagnoses are more limited. This adds to pressure on primary care staff and may reduce patient satisfaction with the service provided.

When the pandemic started, there was already a known crisis in primary care. Unfortunately this is often worse in deprived areas, further compounding health inequalities, which is a major risk factor for covid-19. There have been falling numbers of full time equivalent GPs over the last few years, despite multiple promises from politicians to increase recruitment. In 2015, Jeremy Hunt, then health secretary, promised 5,000 more doctors in general practice by 2020. But instead, we have seen a real terms reduction in the number of GPs, and also 180 practices closed between Feb 2019-2020, averaging 3 per week. Despite that 300,000 extra consultations occurred in primary care in Jan 2020 compared to Jan 2019. The volume of work is higher than ever before with fewer shoulders to share the burden.

Retention and burnout in general practice are a problem. A BMA survey carried out in 2019 showed that GPs are more likely to experience burnout than almost any other group of doctors. 40% suggested they will quit by 2025. The relentless GP bashing during the covid-19 pandemic has had untold consequences on GP’s morale and will no doubt accelerate this.

Last week we witnessed with horror and distress images of foul graffiti smeared across a GP surgery. Sadly abuse is not an isolated incident with a recent poll of 1250 UK GPs carried out by the Medical Protection Society showing that more than one in three GPs have suffered verbal or physical abuse from patients or their relatives during the pandemic. Many primary care staff feel that some of this is triggered by damaging media reports. It is not enough to meekly stand by and nod in agreement that this is unacceptable. Everyone in the NHS has a responsibility to make a stand to end this targeted abuse.

We see the NHS as one symbiotic unit of primary and secondary care, and think we should all be treated with the same degree of respect and understanding in trying to provide services during the pandemic.

Like our secondary care colleagues, primary care staff have been pushed to their limits and we have also devastatingly lost colleagues along the way. This has tragically been disproportionate among our ethnic minority  colleagues. Our thoughts are with them, their families and their teams, along with the families of the 46,229 covid related deaths recorded in the UK to date – many of which might have been preventable.

Primary care has remained open, is working harder and smarter, and is adapting to new technologies, while trying to maintain a routine service, deliver extended vaccinations and safeguard vulnerable patients. As we enter the second wave of the pandemic, with enforced virtual consultations as default, we feel that clear messages on how to access primary care should be a key priority for patient safety, to ensure that the shadow pandemic of non covid work is still treated, to address media concerns and to help protect the wider NHS.

Simon Hodes has worked as a GP partner in the same Watford practice since 2001, and is also a GP trainer, appraiser and LMC rep. The views expressed above are his own. Twitter: @DrSimonHodes

Neena Jha is a salaried GP in Hertfordshire with an interest in emergency care and global child heath. The views expressed above are her own. Twitter: @DrNeenaJha