What possible justification is there for GPs STILL refusing to see patients face-to-face?
We first raised the issue four months ago – but nothing has changed, as hundreds of distressing emails from readers reveal
PINNED to the entrance of a GP surgery on a leafy residential road in suburban Sidcup, Kent is a handwritten note, attached to the inside glass. ‘Please do not punch or kick this door.’ That a message such as this is necessary is truly shocking, but it speaks volumes about the increasingly fractured relationship between the public and the people working in one of the nation’s most trusted professions – the family doctor.
It has been four months since The
Mail on Sunday first revealed the litany of problems that readers had encountered trying to access their GP during the pandemic – and today, it seems, little has changed.
Last March, practices were forced to swiftly adapt to new ways of working after the Government urged them to increase the use of phone and video appointments – a vital step needed to reduce the spread of infection between patients in waiting rooms and to protect staff during the first wave.
Our resident GP columnist Dr Ellie Cannon raised concerns after hearing reports that some practices had all but shut up shop – and hundreds of readers wrote in, describing delays and frustration trying to get through on the phone, being refused face-to-face appointments and struggling to deal with new technology such as video consultations and online booking systems. One half-jokingly described trying to get into their local surgery as ‘like trying to break into Fort Knox’.
LAST week, having been tipped off about continuing problems, Dr Cannon again sounded the alarm – and we have again been deluged with emails and letters. Reports from readers, GPs and anonymous whistleblowers from NHS 111 reveals just how serious the situation remains, with patients forced to go to A&E because they can’t get an appointment. Some have stopped renewing crucial prescriptions, while others have not had blood pressure or diabetes check-ups for 18 months.
Patients with blood in their urine, severe ongoing stomach pain, unusual swellings under the skin and significant, unintended weight loss were all offered telephone appointments only, despite repeated requests to see a doctor.
Significantly, many have told their stories anonymously, for fear of being blacklisted by practices for making complaints.
Under pandemic guidance, practices are advised to screen patients remotely first, a process known as triage – either in a telephone call with a receptionist or via an online form – to decide whether they need a telephone appointment with a GP or can be dealt with by a nurse or pharmacist.
They have to offer face-to-face appointments, but only if this is regarded as ‘clinically necessary’. And this is open to interpretation. Many GPs are happy to see patients if it is simply what they’d prefer – others are seeing hardly any patients in person.
The latter situation is difficult to understand, as GPs and practice staff have all been offered the Covid vaccine, and many by now have received their second dose.
Overall, 60 per cent of adults have been at least partially vaccinated – and 93 per cent of over-50s have had the jab. Covid infections are down to fewer than 4,000 a day – a 28 per cent drop week on week. On April 12, hairdressers, pubs, gyms and libraries will reopen. Yet NHS England has confirmed that there are no current plans to revise the guidance to GPs, although it is keeping the situation ‘under review’ – which means the present situation is set to continue indefinitely.
The overwhelming message coming through from the hundreds of patients contacting the MoS has been incomprehension, despair and – heartbreakingly – genuine distress. As one put it: ‘I have been to my dentist and had my teeth checked. I go to a supermarket with a mask and buy my weekly food, and have even been to my solicitors and had a face-to-face consultation with masks. I have been to A&E because of the excruciating pain I am in. So why can’t I see my GP?’
Another complained that, while a GP refused to irrigate her ears – which regularly block following surgery for a brain tumour – a high street optician offering a hearing aid service was happy to do so.
It’s important to acknowledge that most GPs are seeing patients where necessary – although only 55 per cent of all appointments are in person. This is up ten per cent since October, but significantly below the 77 per cent that were face-to-face before the pandemic began.
We also received letters from readers who praised their ‘hardworking’ and ‘dedicated’ doctors. Most GPs report working longer hours and carrying out more consultations than before Covid. And around half of practices are involved in the vaccine rollout on top of their normal responsibilities. Readers unanimously praised this ‘extraordinary’ feat and expressed their thanks. It’s also vital to note that many patients say they like the convenience of the new system, and more are able to get a same-day appointment, albeit remotely.
But this is not the whole story. Those writing to this newspaper insist calls are going unanswered, online forms are baffling, and turning up at the surgery means being ‘told off’ by reception staff.
One GP, speaking anonymously, said there were some ‘bad apples ruining the barrel’.
Dr Simon Hodes, from Bridgewater Surgeries in Watford, has been seeing patients face-to-face throughout the pandemic, but acknowledges reports on social media which suggest some practices are not.
He adds: ‘That’s a real problem for patients, and brings a bad reputation to the wider profession who are working ever harder to provide a safe efficient service, in addition to the covid vaccine rollout.’
‘You cannot easily assess pain, a lump, or complex symptoms over the phone. And other patients simply want – or need – to be seen in person, which we always try to offer.’
HE SAID remote appointments were appropriate in ‘the majority’ of cases as long as doctors took a careful history, often supplemented with video calls or photos.
But where there are problems, the stories are distressing.
One NHS insider, who has asked to remain anonymous, described how patients at a local practice in Peterborough were being forced to discuss their health problems outside the surgery, on the street, in front of others.
They said: ‘Last week a young woman needed her prescription for antidepressants renewed and was repeatedly asked why by receptionists, outside, in public. Eventually she got upset and shouted that it was because she was suicidal.
‘Another patient had reported a lump in his stomach, which he was asked to photograph and send in. But the lump was below the surface and wasn’t visible – he needed a proper examination.
‘An elderly woman called the surgery on a Friday afternoon with breathing difficulties, and the doctor arranged for steroids to be delivered for her asthma. I later found out she’d died.
‘It’s impossible to know if seeing her would have made a difference, but it’s hard not to wonder.’
A number of patients wrote to say that their situation had become so desperate they paid for private care. Sarah Leaford’s mother, Helen, is a fit and healthy 62-yearold who enjoyed long walks and yoga classes before suddenly developing debilitating problems with her balance. Her GP surgery in Basingstoke refused to see her for an examination, even after she had fallen several times and once given herself a black eye.
Helen, who works for Citizens Advice, was so concerned she borrowed money from friends to pay more than £300 for a private GP appointment. She was referred for an MRI scan and may need hearing aids to address the problem.
Sarah, 33, says: ‘Her surgery wouldn’t consider seeing her until she’d used an ear spray for three weeks. But when it didn’t work they still refused to see her and said she’d just have to get used to the balance problems and ringing in her ears. Mum is fortunate enough that she can pay the money back quite quickly, but lots of people don’t have that ability.’
Sarah, founder of InsideOut Health & Fitness, also had an MRI several months ago to investigate an irregular heartbeat – but has not received the results from her GP.
She says: ‘There’s no point ringing them – they never answer the phone, ever. And there’s no point filling out an e-consult form – they don’t get back to you. It’s making me feel very scared and vulnerable as to what would happen if I were, for example, to find a lump.’
Other health services, such as A&E and NHS 111, are now under additional pressure as patients turn to them instead. One GP who works on the 111 service across the South East said patients were calling the
NHS helpline for advice after failing to get hold of their own doctors, or being told they’ll have to wait weeks for an appointment.
The 111 service can be used to book appointments for patients – but the GP said she was ‘shocked’ by how hard it was.
‘I tell patients I’ll call their GP surgery as I’m a doctor and have more clout, but the vast majority of surgeries have horrendous, off-putting recorded messages – really rude, often saying they’re too busy, and only to call if it’s an emergency.
‘While practices are open, they’re not welcoming and they’re actively putting patients off. I know GPs are working flat out – they’re not on golf courses – so whether it’s a staffing problem with people off sick, surgeries which were already struggling pre-pandemic or general understaffing with the extra pressures, it isn’t clear.’
Dr Renee Hoenderkamp is a GP in North London who also sees patients in a busy hospital A&E unit. ‘I’m seeing patients with trivial things like an ankle complaint or an unusual discharge who have been referred to A&E rather than the GP seeing them,’ she says. ‘These are conditions that aren’t appropriate for A&E and can be easily dealt with by practices. It’s possible some GPs are worried they’ll miss something over the phone.
‘Some people are turning up with itchy rashes or migraines which only started that morning because they genuinely believe GPs aren’t open, which isn’t true, or because it’s more convenient to turn up here rather than wait all day for the doctor to ring them.’
Dr Hoenderkamp acknowledged that there was ‘huge variation’ between practices.
‘I don’t know why we still aren’t seeing more people routinely in person,’ she adds. ‘There’s a reluctance to, even in my practice. I don’t want to be unfair to GPs, but there are some things that need to change. A year ago, GPs were one of the most trusted professions and I wonder where they’d sit now?’
Professor Martin Marshall, chairman of the Royal College of GPs, acknowledges that both patients and GPs prefer face-to-face consultations, but says practices have been adhering to the NHS England guidance. This is designed ‘to maintain infection control in surgeries, keeping both staff and patients safe while keeping services running’, he said.
When NHS England was asked if this guidance was going to change, a spokesman said: ‘GPs have continued to offer face-to-face appointments throughout the pandemic alongside telephone, video and online consultations.
‘Demand for and satisfaction with remote consultations as well as the ongoing risk of Covid transmission means these methods will continue alongside face-to-face appointments and the NHS will continue to regularly review the process for accessing general practice so patients get timely and appropriate care depending on need and preference.’
What’s clear is the current situation is not working for either patients or GPs.
Many GPs took to Twitter last week to vent their frustration at ‘unsustainable’ working practices, and how – some after 20 years of being a family doctor – they are looking for a way out. Many say unbearable workloads and staffing shortages pre-date the pandemic, and have now been exacerbated by it. But all patients want is quality time with their valued doctors.
It means there is one thing everyone agrees on: things have to change before relations break down for good.