I hated the Thursday evening doorstep clapping during the pandemic; I knew exactly how things would end. The clapping was a hollow and shallow gesture — it was painful to endure. Once the immediate threat of dying had subsided and faded into something we have just “learnt to live with”, people have gone back to blaming GPs for being lazy and money-grabbing. I’ve been a GP for the last 16 years and I’m tired of it.
I don’t know what else we can do to prove we are working as hard as we can and seeing all patients who actually need to be seen face face. Pre-pandemic we saw approximately 80 per cent of our patients face-to-face. We are currently still seeing 60 per cent of our patients face to face – and the other 20 per cent fall into the category of ‘safe to be managed remotely’.
But everyone has made their own mind up as to what they think their GP is doing – and no amount of shouting about how hard we are working seems to be going into anyone’s ears. It feels like shouting into a bottomless cavern – no one is listening.
I’ve work as a locum GP in east London, Kent and Sussex, so I have a very broad understanding of the difficulties the NHS is facing across the country. The job has changed enormously over the last two years in terms of workload and the volume of patients we are seeing. There have been many challenges, but the main one is simply the sheer volume of patients we are seeing – patient contacts are up by approximately 8.5 per cent compared to this time two years ago.
Given that we were already at a breaking point with our workload pre-pandemic, this increase in workload, combined with the public perception that we are “closed” and “not seeing patients face to face”, has just felt like a very heavy and depressing burden to carry.
I’m very used to doing remote consultations, they don’t phase me. I did them pre-pandemic working for various digital healthcare companies, and I am confident enough in my clinical ability that I am able to identify when patients do or do not need face-to-face assessment. The truth is that a large portion of patient-facing GP work does not in fact require a face-to-face appointment. Medication reviews, repeat prescriptions, reviews of chronic conditions… much of this can be done, and is done, very safely whilst working remotely.
The more nuanced and subtle aspects of general practice are lost with remote consultations – we know that
The rest of patients who do require face-to-face assessments are still, in fact, being seen – it’s just that their first point of contact will be a telephone or video call, to allow us to triage them and assess the need for a face-to-face appointment. The simple reason for this is to help us manage the workload. We are not “hiding” from the virus, we are implementing a system of patient triage to allow us to see the largest number of patients in the most efficient way. A telephone appointment takes much less time than a face-to-face appointment, which is the main reason we are currently operating in this way.
The main downside to consulting remotely is not actually the lack of physical examination, it is the more nuanced and subtle aspects of general practice which are being impacted. The opportunistic chat with an exhausted mum who has turned up for an appointment for her child, but is clearly struggling with her own mental health; the eagle-eyed GP who notices a possible skin cancer on the nose of their 80-year-old regular who is there for his BP check; the quiet, withdrawn child with unexplained bruises, at a check-up for something unrelated. Those are the things GPs are trained to pick up on. We often call it our “spidey sense” – a feeling that something isn’t quite right, and needs further digging and exploration. Those are the things which are lost in remote consultation. We know that.
Of course, we also know that there are vulnerable sections of the population who would almost always prefer – and would benefit from – a face-to-face appointment. This applies in particular to the elderly population, and those people are, by and large, still being seen face to face – it’s just that we have to manage our workload by speaking to them on the telephone first.
As for the reports that some GPs are refusing to see any patients face-to-face, I don’t know a single practice that is working in this way – and I work across a large geographical area for lots of different practices. If there are any who are genuinely refusing to see patients face-to-face, I can only imagine that it’s because they are simply overwhelmed by their workload and do not have the capacity to see any of their patients in-person.
How would people feel if GPs disappeared altogether? It’s a strong possibility
In general, GPs are expert communicators, decision-makers and clinicians working in a pressure-cooker environment – we have adapted to the ever-shifting sands of the pandemic from the outset. We have delivered a highly successful vaccination programme and have continued to do all of our usual clinical work, administrative work and then some – in the face of being ill ourselves, having colleagues becoming ill, and in some cases dying.
At the end of the day, we are humans who are doing our level-best to keep the NHS together during the biggest health disaster our generation has seen. There is only so much abuse that we can take – many GPs are choosing to retire early or leave the profession altogether because they just can’t take it anymore.
I wonder how people would feel if GPs just disappeared altogether. It’s a strong possibility, given that we actually have 1,500 fewer GPs working today than we did six years ago when we were promised an extra 6,000 by 2021 by then-health secretary Jeremy Hunt. No one wants to do the job anymore because it literally makes people ill. According to the BMA, 57 per cent of doctors are living with one or more mental health conditions.
We’ve been on our knees for years but the pandemic has left us completely and utterly floored
Do I blame Jeremy Hunt? I don’t blame him specifically. He was acting as part of a government which has systemically defunded the NHS for years – cutting budgets, closing down clinics and services, slowly eroding NHS staff to the point where we feel about as valued as dog faeces on the soles of their Ted Baker brogues. There is no single person to blame for the situation we currently find ourselves in. It is simply the perfect storm – a global pandemic occurring at a time where GP services and the NHS were already on their knees. We’ve been on our knees for years – doing the best we can with what we have. But it’s been nearly two years now, and we are utterly exhausted. Broken. Completely and utterly floored.
We are trying to plug the gaps in this sinking rowing boat – with chewing gum and dirty rags – but the water continues to pour into the boat, and we are going down with it. The general public and the government need to put their pitchforks down and really listen to us. We are human beings who went into medicine because we care about helping people. We are not the evil, money-grabbing, golf-playing elitists that many right-wingers would have you believe. What the government is doing is whipping up the perfect storm to privatise the NHS once and for all – and to scapegoat the GPs for its downfall. Instead, they need to listen, before it’s too late.
Dr Zoe Watson, 39, has been a qualified doctor for 16 years. She currently works as a locum GP across east London, Kent and Sussex.