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Published:
10:15 am 15 January 2022
Just before Christmas, an 85-year-old lady called her GP. She was anxious and had trouble staying home.
The GP knew he should spend time talking about it and offering help, but he had two distressed palliative care patients, a patient with a possible blood clot in his lungs, a probable case of sepsis due to a kidney infection, a patient with a possible bowel obstruction refusing admission to hospital, and a suicidal patient whom the practice could not reach by telephone.
All he could do was give her the social services phone number.
General medicine should be about more than crisis management, but today’s general practitioners simply have to survive.
There is no time to delve into the ideas, concerns and expectations of patients.
A colleague said he had to become an “emotionless machine”. One practice told me demand was 31% higher than before the pandemic.
A face-to-face consultation takes as long as three phone calls. On a normal day, GPs often handle more than 80 phone consultations, sign 150 prescriptions, review 50 lab results and read 50 hospital letters, in addition to seeing patients.
Every one of those letters, phone calls, prescriptions, or lab results can be vital to a person’s health.
Could there be warning signs of cancer buried in the flood?
Patients naturally get angry, unfairly blame GPs and abuse the practice team.
The only way to cope is to start working very early, work in the evenings and catch up on paperwork in the evenings and on weekends.
The whole situation is exacerbated by the media implying that GPs are on the golf course.
How many people realize that high performing vaccination centers are largely run by general practitioners?
Why is the NHS dealing with this crisis?
Covid is only partially to blame. Before the pandemic, the NHS was on a knife edge.
The UK has fewer intensive care beds than most other European countries with 10.5 per 100,000 population compared to 33.9 in Germany and 16.3 in France.
In 2017, the British Medical Journal published figures showing that Austria has 5.1 doctors per 1,000 inhabitants, Germany, Italy, Lithuania, Norway and Switzerland have more than four while the UK has only 2.8.
In Torbay we have particular problems.
Between 2004 and 2020, the population increased by almost 17%.
Between 2020 and 2030, the council estimates a further increase of 6.1%.
The number of GPs has not followed.
Torbay is ranked as the most deprived local authority in the South West with one of the highest levels of domestic violence in the country and levels of alcohol abuse and mental illness above the national average.
This tsunami hit GPs when they were already facing serious problems.
General practitioners are self-employed and run their own practice.
In the old model, a new GP partner would take out a large loan to buy the practice, stay for 30 years, and be bought out when they retire.
It worked in 1948 but the world has changed.
Many new GPs do not want to join a partnership. They already have a big student loan and don’t want a long-term commitment.
Therefore, GP practices cannot recruit new doctors. A local practice has only three partners serving more than 16,000 patients.
If the practice squad self-isolates due to Covid, the situation escalates.
As the pressures increase, some doctors are leaving general practice, increasing the pressures on those who remain.
Practices are increasingly using paramedics, pharmacists and nurses to take calls, but they need GP support.
As work becomes increasingly stressful, very few young physicians opt for a career in general practice.
I wish I could provide an offhand solution, but all I can say is that GPs and their teams are struggling hard against incredible pressures.
Blaming the GP for the service is like blaming the captain of the ship for the storm.
They face a situation that is no longer tenable.
All they can do is try to avoid sinking.
