NO wonder Sajid Javid didn’t want to face England’s GPs yesterday – even via pre-recorded video message. Such is the strength of anger at his plans to improve patient access, he may have been concerned the booing from the Royal College of GPs (RCGP) conference in Liverpool would have been audible as he visited a surgery in London.
Perhaps the English Health Secretary has been reading up on reverse psychology. How else does he imagine that the solution to the UK-wide shortage of GPs is to pick up an enormous stick and use it to thrash those who are currently working in general practice, suggesting they are workshy and letting their patients down? Has he actually thought through the impact of his approach, beyond a clutch of positive headlines in the Daily Mail?
READ MORE: Tories fail in 'reckless and premature' bid to have GPs back face-to-face
The Tories seem to be labouring under the misapprehension that they hold the power here; that when they shout “Jump!”, GPs will ask how high. They are wrong for two reasons.
Firstly, as GPs are not NHS employees – the government cannot directly dictate their hours, pay or the way practices operate. Secondly, there simply aren’t enough of them, and antagonising them is only likely to exacerbate that problem. Tell them to jump, imply they are hiding from their patients while raking in huge salaries, and they instead might opt to take early retirement.
A recent survey by the General Medical Council found that more than four in ten GPs who quit the NHS between 2004 and 2019 did so due to burnout, yet the UK Government’s response is to suggest the current workforce is workshy and lazy.
Professor Martin Marshall, chairman of the RCGP, hit back in defence of GPs, saying: “The malicious criticism of the profession by certain sections of the media and some politicians as a result of the shift towards remote working – introduced to keep our patients safe and our teams safe and keep the service operating – has been the worst I can remember in over 30 years as a GP.”
Javid (above) has unveiled a £250m funding pot that will be made available to GP practices so that they can hire extra staff such as physiotherapists and podiatrists, or indeed locum GPs (assuming they can source any). However, access to this money will be conditional on practices offering “appropriate levels of face-to-face care”. The clear suggestion is that without this multimillion-pound carrot, practices will carry on operating inappropriately. Who will define “appropriate”? And how will “naming and shaming” practices with the lowest levels of face-to-face appointments help anyone?
The pandemic resulted in a huge shift away from in-person appointments towards online and phone consultations, and now Javid wants everyone in England to know which practices are dragging their feet and not returning to normal quickly enough. This assumes that returning to normal is desirable, and that it’s achievable in the current context of dwindling GP numbers.
READ MORE: GPs' 'unmanageable' workloads spark calls for long Covid clinics to be set up
The preoccupation with face-to-face appointment numbers ignores the fact that other types of consultations have worked well for some patients, not just because they minimise the risk of Covid transmission but also because they are more convenient and result in the patient speaking to a doctor sooner. They have also reduced the problem of appointments overrunning (presumably because it’s easier to wrap up a Zoom call than to physically bundle someone out of a room), and in turn the amount of unpaid overtime worked by GPs just to ensure everyone in the waiting room is seen.
The demographics of a practice’s patients will surely influence the kinds of appointments it provides, with working-age people presumably more likely to favour Zoom appointments they can fit around work and caring commitments, and older people with more spare time (and more complex health needs) preferring to attend in person. So what useful information will league tables of appointment provision actually offer? Is the risk of being “shamed” supposed to motivate practices, or is the expectation that patients will start switching GPs in order to chase face-to-face appointments that become increasingly illusory?
Humza Yousaf will doubtless be taking heed of the responses to the UK Government’s plans, including the howls of outrage from GPs. Might some of them be open to a move north if it would mean being treated with a little more respect?
Instead of fixating on the format of appointments offered, wouldn’t it make sense to focus on ensuring patients aren’t being driven to A&E departments due to the difficulty of getting an appointment – any type of appointment – at the local surgery?
From officious receptionists to engaged phone lines to bizarre hoop-jumping exercises, every one of us probably has a gripe about barriers to accessing urgent frontline medical care. What can be done to ensure those in greatest need get to the front of the queue?
There will be no easy, one-size-fits-all solution. But one thing’s for sure – “naming and shaming” will not lead to the desired outcome.
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