LET US ALL SEE OUR GPs FACE TO FACE
It was last November when we first highlighted the frustration and fears of readers only allowed phone or video calls with their doctor. By Febraury nothing had changed – nor has it now. So today we launch a campaign urging NHS bosses to...
IF THERE is one story which encapsulates the distress of f amilies as GPs r emain behind closed doors during this pandemic, then this is it. And to health chiefs who continue to insist patients should only be seen face-to-face where absolutely necessary, it should serve as a warning shot: to open up ALL surgeries again, or risk many more families being devastated, just like this…
It was October last year, before the second wave of the pandemic had
taken hold, when Elaine Gordon contacted her GP practice in the North West.
Fit and healthy, and in her mid-50s, Elaine rarely bothered her doctor.
The former nurse, a devoted grandmother, was a full-time carer to her husband Mark, who has latestage multiple sclerosis and is no longer mobile.
Her sister-in-law Sarah describes her as ‘robust’ and ‘the glue that holds our family together’. But she had become so unwell she was unable to get out of bed. In her groin was an unusual swelling.
Her GP practice offered her a telephone call with a practice nurse, whose first question was whether she had had any new sexual partners. The insensitivity, given the practice’s knowledge of her husband’s condition, distressed Elaine so much that she put down the phone in tears.
Over the next few weeks her condition deteriorated rapidly.
She lost three stone in weight, was unable to stand for more than a few minutes and was covered in unexplained bruises and boils, along with the swelling in her groin.
There were regular calls to the GP practice, often from Elaine’s two daughters who were desperately worried about her, but she was still not offered an appointment – either by telephone, or face-to-face – with a doctor.
In late November, Elaine was seen by a practice nurse, who carried out some blood tests. The results, sent to the practice from the laboratory, recommended she was referred to an oncologist, and the surgery invited her in to discuss them.
BY THEN, Elaine could not stand unaided. Yet reception staff initially refused to let her in the building, insisting face-to-face appointments were for ‘serious cases only’. Her GP did refer her to a cancer specialist, but insisted it was unlikely to be ‘anything sinister’. He was wrong. During a hospital appointment, Elaine was told she was not only in kidney failure, but seriously ill with rare and highly aggressive Burkitt lymphoma.
Four rounds of chemotherapy later she remains in hospital, her prognosis uncertain.
For this type of blood cancer, catching it early is key. The hospital has written to Elaine’s GP surgery to establish why she was not seen sooner – but there has been no reply.
Elaine’s sister- in- law Sarah contacted The Mail on Sunday after reading t he ‘ horror stories’ from other desperate patients who have struggled to see their family doctors throughout the pandemic.
Although they wanted their story to be told, Sarah asked us to use pseudonyms, for privacy reasons while Elaine remains in hospital. We, of course, agreed to this.
‘People are dying because they’re not able to see their GP,’ Sarah says. ‘We are completely devastated by what has happened to Elaine.
‘ What she experienced wasn’t care, it was an absolute lack of it. Worse, it was disinterest.
‘To compound it all, my brother has been refused even telephone appointments despite his records clearly showing he is extremely susceptible to chest infections and may need antibiotics regularly. Twice my nieces have resorted to calling 111, which despatched an ambulance.
‘When one of my nieces finally lost her temper and raised her voice to the practice manager, she was told that her call would be terminated because she wasn’t being “very nice”. My niece pointed out that almost killing their mum and dad was also not very nice.
‘The distress and despair caused to our family has been shocking and, it seems, is being repeated for patients and their families across the country.’
Sarah is right – at least, if the 1,000-plus letters to The Mail on Sunday are anything to go by.
Since November, when we began writing about the problems patients have experienced trying to contact their GP during the pandemic, they have been piling up. And the latest batch, over the past month alone, are the most distressing yet.
A significant number des c r i be going to A&E after bei ng unable to even get through to their GP on the phone. Some were hospitalised with conditions which, had they been caught earlier, could have been easily treated at home. Others, heartbreakingly, have endured the death of a partner.
Eric Jones, 76, lost his beloved wife, Joyce, 75, last August to lobar pneumonia, which developed into deadly sepsis.
Her condition was misdiagnosed as a simple chest infection during a telephone consultation with her GP. Eric tells the story in the panel on the right. That s urgery doors r e main largely closed is becoming increasingly incomprehensible. Over the past week, new Covid infections have fallen to an average of 2,000 a day, and deaths to single figures. Scotland recorded a week with no deaths at all. In a week’s time, pubgoers will be able to enjoy an indoor pint and the Government has published a ‘ green l i st’ for count r i e s we can t r a vel t o a nd f r o m wi t h o u t restriction. But t he guidance on how surgeries should operate during the pandemic, introduced by NHS England, remain firmly in place – and today, The Mail on Sunday launches a new campaign to demand a shift in thinking. While digital and remote services have offered convenience to some, they have caused much misery to many others. And so we are demanding that
NHS England changes its guidance so all GPs must prioritise seeing patients face-to-face again – and that they are given enough resources and support to do so.
GP leaders point to the fact that the proportion of appointments being held face-to-face is recovering. That’s true: NHS Digital figures show the number of patients being seen in person in March had doubled to 15 million, compared with the first wave peak in April last year. That represents about 55 per cent of all appointments, still significantly down on the 80 to 85 per cent face-to-face consultations before the pandemic.
But a closer look at the figures reveals that only about a third of these were actually with GPs – the remainder were with nurses and other healthcare staff. Before Covid, the majority of in-person appointments were with GPs.
This situation is unlikely to get much better. In fact, the Government wants these changes to be permanent. An NHS England paper published in March says that even more appointments should be online in future.
This is about adopting what it calls ‘total triage’.
This policy is what’s happening now – patients explain why they want to be seen by completing an online form or speaking to a receptionist, and staff will then decide whether they need a telephone appointment with a nurse, GP or other healthcare worker, or whether they should be seen in person.
This was always on the cards even before the pandemic, but some say Covid has provided the perfect excuse to speed up its delivery.
A reader from Essex, who asked not to be named, said: ‘I’m all for some sort of triage but we must be allowed to actually physically consult with our GPs again. My biggest worry throughout this pandemic has not been catching the virus but that things, in every walk of life, would never go back to the way they were, and it seems that is going to be the case.’
Two readers contacted us to say their GP practices, both in Kent, had already announced they would be ‘ digital first’ permanently – which means all appointments will have to be booked online.
This was described in patient leaflets as an ‘upgraded service’ which meant patients would no longer ‘wait in a phone queue to speak to the surgery as patients can quickly and easily make contact online’.
Such measures are designed to ease problems that existed long before the pandemic. Over the past decade, hundreds of practices have closed or been merged despite a growing population, while many GPs are leaving or retiring early due to burnout or stress, and fewer are being recruited.
The pandemic has simply exacerbated those issues, according to senior doctors, while the vaccination programme has added additional pressure to an unprecedented workload.
According to Dr Alison George, a GP who chose to begin working in A&E last year after her practice elected to continue with remote
appointments, the current model is ‘failing patients’ and ‘like practising medicine blindfolded’.
‘This is a catastrophe waiting to happen,’ she says.
‘Remote consulting definitely has a place in modern primary care, but it is not in the best interests of patients or GPs. I’ve had patients coming in to A& E, delirious with sepsis, who would have been given a mental health referral over the phone. They would have died overnight had they not come in. ‘I’ve spotted melanoma skin cancers in patients who’ve come in for other problems, and Parkinson’s in a patient just because of the way she walked into the consulting room, but the digital model removes the option of opportunistic or preventative healthcare. It treats a symptom, not the patient.
‘This is a cheap way of dealing with the problems in GP recruitment and it’s outrageous. Of course, those who support it say GPs do still have the option of seeing patients in person, but we know from the current situation that this is simply not happening in some cases.
‘ All GPs need t o be s eei ng patients in person or we risk a disaster in primary care – I’m already seeing the results of it in A&E.’
There is also evidence the shift to online is, paradoxically, increasing that workload even further – by making GPs easier to access.
Some practices in Kent have even been turning off their online forms in the evenings and at weekends because they have been ‘inundated’ with demands.
This is backed by a study by Chris Salisbury, a professor of primary care at the University of Bristol, which found ‘digital first’ access, using online consultation forms, drove GPs’ workload up by 25 per cent because many patients needed to be seen again in person.
One GP practice even wrote a letter to its patients last week, essentially blaming them for a flood of enquiries which overwhelmed its service.
Ivy Grove Surgery, in Ripley, Derbyshire, said patients weren’t doing enough to look after themselves and were presenting them with ‘a shopping list of multiple problems’. ‘We are quite sure that you would not see your solicitor in a single appointment slot (however long might be allocated) and present them, without warning, with an employment contract issue, a divorce issue and a boundary dispute issue, all of which need resolv
ing by the end of the appointment,’ the letter read. ‘However, as GPs, we are frequently expected to deal with three or four problems within a ten-minute time slot.
‘That is exactly 150 seconds to deal with each problem. Count them. You will all know that this is not humanly possible with the laws of physics being what they currently are.’
Many GPs have applauded the letter’s honesty, but others said it was inappropriate to blame patients for its problems and would add to their misery.
Speaking to The Mail on Sunday’s Medical Minefield podcast last week, the chair of the Royal College of GPs, Professor Martin Marshall, acknowledged that both staff and patients were stressed and unhappy with the current situation. While it is wrong to blame patients for today’s pressures, he said it was also wrong to blame family doctors.
‘There simply aren’t enough GPs to provide the kind of care we used to provide,’ he said. ‘This is a crisis which only policymakers can sort out. And it doesn’t seem fair to be blaming GPs for what is essentially a lack of resources.’
OMINOUSLY, he also suggests remote services may become the new normal: ‘General practice is changing. And I think it will take some time for the public to get used to that.’
This will come as no comfort to the scores of readers who write to this newspaper, exhausted and upset by the situation.
One 83-year-old, who has been with the same practice for 50 years and lives with asthma, Crohn’s disease and chronic obstructive pulmonary disease (COPD), told us: ‘I am obviously of no interest because of my age, and for the first time in my life I am suffering from depression.’
Another reader, writing about her 96-year-old aunt who has no mobile phone or internet access, said her GP failed to contact her about her Covid vaccine.
‘ We have since found out that others who do not have access to modern t echnology were also missed off the list,’ she wrote. ‘It appears this surgery doesn’t know how to use a landline.’
But even those who can use the t echnology f eel l et down. Di Heenan, in Manchester, also ended up on an antibiotic drip in hospital for 24 hours after her GP, during a video call, said her foot infection was ‘just a big blister’. ‘I wasn’t happy – and neither was the A&E doctor,’ wrote Di.
Julie Shepherd in West Sussex said she and her husband managed his diabetes ‘all on our own’ following an operation to remove part of his pancreas just before the pandemic. ‘He has experienced sepsis three times in the past year and we have had to fight continuously to get his prescriptions, battling our way through the surgery’s phone call system and the receptionists,’ Mrs Shepherd said.
‘If it hadn’t been for the fact that I work for the NHS and have contacts at work, my husband would probably be dead.’
SHE added: ‘We now have no faith at all in getting any help if he is sick again. I don’t bother any more – I just take him to A&E, like I did last time when he had chest pain and breathing difficulties and ended up having a coronary stent inserted.
‘ Perhaps if he had his regular check-ups and someone from the surgery had followed him up, this could have been avoided.’
Yet another reader, whose wife had previously been diagnosed with the blood cancer chronic lymphocytic leukaemia, was told to try throat lozenges during a telephone consultation when she complained of breathlessness and problems swallowing.
He chose to have her seen privately – and the consultant immediately admitted her to hospital and diagnosed her with an aggressive non-Hodgkin lymphoma, which had spread to her lungs, and sepsis.
‘I have no doubt whatsoever that, had I not paid privately to see that consultant, my wife wouldn’t be alive today,’ he wrote.
‘The whole practice is an utter disgrace as they have lost sight of why they are there. Their attitude is putting people’s lives at risk – but they couldn’t care less.’
One concerned patient from Kent speaks for everyone. She wrote: ‘It is time, urgently, for NHS England to rectify the situation.’
NHS England was asked about the detailed concerns raised above, but failed to add anything to its previous statements. A spokesman said GP ‘teams’ were offering faceto-face appointments, and added the NHS would ‘continue to regularly review the process for accessing appointments’.