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Secret Diary of a PM: The Doctor Will (Still) See You Now

It is never dull in primary care, that’s for sure. This last month has been a rollercoaster, with announcement after announcement of what primary care should, or should not, be doing with the agenda being run by the media and not the government.

Access is the hot topic and the fury whipped up by the media has impacted on all surgeries, and we are all cast as the bad guys, which seems to suit the government’s agenda.

The truth, in my view, is far from the lies reported. I will accept that some practices may have hidden behind technology but in the main, practices have been offering face-to-face appointments where necessary and are now offering even more. Where I work, and within the PCN, as well as where I am registered, it is business as usual. Despite the views of some, we do care for our patients as well as our staff.

Contrary to the media headlines, we always had face to face appointments throughout the pandemic—after a telephone triage, and where the clinician thought it was essential for the patient to be seen. Most patients were happy with the procedure, and lots of consultations were able to be done without it being face-to-face.

Over the last few weeks, we have gone back to even more routine appointments being in-person. Strangely, this week alone we had a large number of face-to-face appointments not filled. In fact, we had tried everything to fill these slots and patients were saying they feel safer over the phone, so you just cannot win. I bet this is not unique to our practice—it would be interesting to see if anyone else has had similar issues!

I will say that the level of abuse has gone through the roof, like everywhere else. A practice in Staffordshire had to close for two days last week as the staff could take no more.  In another incident, a GP suffered a fractured skull and three other people were injured. This week, I have had to deal with situations in reception every day, when patients were demanding things we could not do.

A mother was angry that her teenage daughter wanted antibiotics and was asked to present face-to-face. She refused, saying she was in Bristol at university, so we told her to visit a walk-in centre. When she did, she was refused the antibiotics and advised to use over-the-counter medication instead. The mother thought it was disgraceful—her husband is a pharmacist, and knows his daughter needed the antibiotics, even when she was two hundred miles away! This exchange took over 20 minutes and left me exhausted, arguing (ever so nicely) that it was not our fault. She has promised to take it further.

A GP needing to admit a patient to hospital this week was met with the ambulance service saying it would be at least nine hours. Coming at 3pm would have meant someone staying until midnight to look after the patient, as she had no family. What were we supposed to do, give her a key and tell her to lock up when she leaves?

The GP involved wanted to take her to hospital himself in his car, and we had to stop him. There were risks involved and, in any case, they were needed to complete surgery (another one of our ‘uncaring’ GP’s!) We eventually paid for a taxi for the patient to take her to A&E as we did not want her to go home and be alone.

We can all relate to such incidents, and it does get wearing as it takes time. We all have to be so careful that we don’t “do the wrong thing for the right reasons”.

How much time have we spent trying to get people from overseas, now working in the UK, a second Covid jab, when 119 just repeats the same mantra to the patient: “speak to your GP”?

Then came the announcement that the Health Secretary was likely to insist that masks did not need to be worn, nor any social distancing needed in practices, and as a result this would increase access! Who produces such ridiculous ideas, especially when the daily rate of Covid is climbing? We will not be removing social distancing and will still be encouraging masks to be worn.

 

New funding—solid support or media smokescreen?

The extra £250m winter funding recently announced comes with several caveats: we must increase FTF consultations, and we should be attracting retired GPs. If this is the situation that awaits them, are they really going to want to come back?

Where are they going to work from, and will extra IT equipment be available? I doubt it—we have been trying to get extra IT for additional rooms and staffing and our requests have consistently been rejected.

This money can also be used for security, which must be an admission of the increase in violence and abuse of staff. A lot of the anger is fuelled by (let’s politely call it) ‘mis-reporting’ and is being whipped up by this negative assault on primary care, and little or no support from government.

I have been a practice manager for nearly 20 years, and I have never known a period as stressful and tiring as this; when I’m attending meetings online, I can see the desperation of colleagues—both management and clinical—and morale is exceptionally low.

The system is close to breaking, there is no argument about that, and still more and more pressures are being put on primary care, with valuable and skilled people leaving in droves. We need leadership and support from professional bodies to voice these concerns and fight our corner.

I challenge any MP or news reporter to spend a week in practice to see the reality of the situation rather than make unachievable promises to the general public.

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