View From the Ground, by Dr Claire Davies
Primary care has its back to the wall right now. Many practices are trying to manage the rising tide of demand, and are only just keeping on top of it. This demand is driven by multiple factors, including patients seeking help for problems that they did not attend with during periods of lockdown, mental health issues related to the pandemic, the hospital outpatient backlog, and the introduction of digital consultations. The move to ‘digital-first’ consultations has meant that there is no cap on the number of consultations per day—I now face up to 200 e-consults and telephone requests to triage within the first 2 hours of each day, a workload that is neither safe nor satisfactory. GPs have also delivered the bulk of COVID-19 vaccinations—a poorly acknowledged fact, given that the vaccination programme, combined with periods of national lockdown, has allowed a period of time when normal freedoms were possible.
Why should there be such a vicious backlash against GPs? The press has accused GPs of ‘hiding’ behind remote consultations,1 and meting out ‘cruel, negligent and, frankly, inhuman treatment’.2 On the contrary, general practice teams have shown themselves to be nimble during the pandemic, moving to remote consultations overnight—as per the directions of NHS England—and delivering the COVID-19 vaccination programme on a shoestring budget. Hospital outpatients, by and large, still offer remote consultations first—why is there criticism of primary care but not of hospitals?
A primary care service driven by social values is at odds with the UK’s capitalist economic system, as is the independent contractor status of GPs. Does the pandemic represent a convenient opportunity for the Government to let primary care drown and then point out that it needs replacing because of poor performance? The flawed Winter Access Fund, which initially tied its promise of emergency funds for general practice over the winter period to targets on face-to-face consultations, demonstrated that the Government is ‘ignorant to the needs’ of general practice.3
As well as the hostile political environment, there are psychological forces at play. GPs have always been much more accessible than hospital consultants. It’s easy to criticise GPs, whether at reception, over the phone, or on the practice Facebook page, but primary care does an incredible job of supporting people living at the margins of society, and individuals with complex situations. We can move increasingly to digital and remote consultations to deal with demand, but society is a lonely place for many, and isolated people fill the gap through interactions with their doctor. There is a strange dynamic at play in which hospital doctors and nurses are hailed as heroes, the public as innocent victims, and GPs as perpetrators. Rather than GPs being viewed in this way, it is important that their true contribution is recognised.
Many GPs have spoken publicly about the hours that we are working, the struggle to keep up with consultations, the physical and verbal abuse that we face, and the high rates of burnout within our teams. The British Medical Association has recently balloted its members on industrial action,4 but will any action taken be sufficient? We are trying to win hearts and minds with facts and figures, but we also need to appeal to people’s emotions. We can’t fix everyone’s problems, but we must remind patients that, in a society where the gap between the ‘haves’ and ‘have nots’ is increasing, we are on their side. Primary care is a safe space—a place of trust and wisdom and cradle-to-grave care—even if it looks a little different as a result of the pandemic. A GP is a precious resource—not just an expert in health, but in life—and patients would miss primary care were it to disappear.
Dr Claire Davies