Harry DE QUETTEVILLE
It’s not just patients who are fed up with a dysfunctional system, reports Harry de Quetteville
Two contrasting statistics exemplify Britain’s dysfunctional relationship with the NHS. Marketeers say it is Britain’s strongest brand, its workers trusted as no others. And yet yesterday a new survey found that around a quarter of patients felt they had to fight for treatment, or to be taken seriously, with more than a fifth forced to go private to get care.
Nowhere else would such poor customer service be rewarded with such glowing customer reviews.
Video contributions to the survey are shocking; witness statements testifying to often awful, basic mistakes which in turn have led to lasting illness, impoverishment or anger. As for free at the point of care, listen to the woman who considered taking her own life while she waited and waited for an operation, and eventually remortgaged her house to pay for private surgery. No wonder Spire, Britain’s second-biggest private healthcare provider, has just announced record revenues from such uninsured self-funders.
Yet the starkest gap between how we want the NHS to be, and how it actually is, comes in general practice. It is in this aspect of the nation’s health provision, found a recent poll for the Patients Association, that most Britons have struggled to access care. Before the pandemic, a quarter said they found it hard to see a GP. By April this year, that had risen by half to 36 per cent – worse than for any other NHS service. And now, a survey conducted over the summer reveals, it has jumped again, with 52 percent finding it hard to get a GP appointment. “GPS are the front door to the NHS,” notes the Patients Association, “and patients are increasingly perceiving that that door is closed to them.”
The impact is very real. Some 56 per cent of patients admit to putting off appointments, and more than half also expect their health to suffer as a result of changes to provision during the pandemic. The toll may already be emerging. For the last 18 months the number of so-called “excess
GPS find themselves shorn of the human relationships that made them so valued
deaths” in private homes has remained stubbornly above the five-year average. The latest figures, for the week to August 27, reveal that some 724 people more than usual died at home – 32.5 percent above the norm. A single coroner in Manchester alone has linked five deaths to information that may have been missed through the lack of face-to-face consultations.
Some former GPS and their families find the situation appalling. One GP’S widow, now waiting months for a painful procedure, recalls the many nights her husband spent on call caring for cancer patients. When he was dying of the same disease, “the GP practice never showed up at all! How times have changed!”
When they can get through the door, patients report often being met with suspicion. Despite statistics proving patient reticence, some surgeries have taken to posting letters on their websites bemoaning those whose “first port of call is always the GP, often requesting urgent attention”. Yet that attention can sometimes be critical, as with the 87-year-old patient fobbed off with an appointment for two days later, who went to A&E and immediately had a life-saving intervention. “He will never trust his GP again,” notes his son.
According to the UK charity Healthwatch, which produced a report on access to primary care earlier this year, patient problems with GPS fall into four broad categories. The first is miscommunication about changing protocols for contacting a surgery in the first place, of being bounced from reception to e-consult, and back again.
The second is access to appointments themselves. GPS are the gatekeepers to NHS care, with the power to refer patients – or not – to specialist consultations and diagnostic tests. Now, however, some patients feel that receptionists or healthcare assistants are the gatekeepers to GPS. Universal triage, which was originally introduced, according to government regulations, “to enable early recognition of Covid-19 cases” has now become entrenched. Dr Jon Griffiths, a GP in Cheshire, notes in a blog entitled What are GPS actually doing? that “most GPS have continued with the practice of phone calls first... This is why you cannot, in most places, directly book a GP surgery appointment like you used to.”
Some disgruntled patients have even taken to calling triage receptionists “rottweilers” who stand between them and their GPS. Others have bundles of horror stories: triage which failed to pick up on strokes, or strangulated hernias.
Griffiths suggests that “most GPS have found that they can adequately assess, advise and treat many patients using a phone or video consultation without needing to trouble the patient to attend the surgery”. The problem
with this is that many patients feel the opposite. As the Healthwatch report points out: “remote consultations are mainly by telephone. Patients often find these a poor substitute for face-to-face contact.” This is the third big problem. The NHS, the Patients Association adds, “must restore face-to-face contact as the default form for GP appointment”.
If one-off appointments are tricky to secure, those with long-term conditions have suffered particularly.
This is the fourth big issue – dwindling access to regular health checks, with reviews of treatments and medications, which are critical to managing a condition.
In a recent interview with the Guardian, Prof Martin Marshall, chair of the Royal College of GPS (RCGP), said that GPS were overstretched and underfunded, “working 11-, 12-hour days, seeing 50, 60 patients”. He said that such pressure made it “increasingly hard to guarantee safe care”.
Yet in the past decade or so, according to the Institute for Government, funding for GPS has increased by 20 per cent in real terms, while estimated demand increased around 9 per cent. Meanwhile, latest figures show GPS now earn an average of £100,700. Only 11 per cent of GPS now work on once-standard full-time contracts for a single surgery; their places have been taken by a dramatic upswing in locum doctors. Even before the pandemic, Charlie Massey, chief executive of the General Medical Council, noted that “Doctors... are no longer prepared to stick with the traditional career paths”, adding that instead they were “making choices for a better work-life balance”.
Early retirement is not helping. New figures from the BMA, the doctors union, reveal that the average GP retirement age is now 59. Marshall defends this, saying GPS are leaving early because of overwork, and that they “don’t want to die in the harness”. But this seems to contradict even the BMA’S own research which shows that “over half of doctors plan to retire before the age of 60, with the majority citing pensions taxation as their primary reason”.
The result is that pay-for services offering appointments with private GPS are flourishing. One private GP reports receiving “at least five calls a day [from patients] asking for us to take them on”.
Another, Charles Levinson, CEO of Doctorcall, reports that today’s system is an unhappy compromise in which both patients and doctors are miserable. After decades of pushing for more perks, Levinson says, GPS have found themselves shorn of the long-term human relationships that once made them and their skills so valued to their communities.
“There’s nothing like visiting a patient at home in a crisis. You have a bond forever. But today’s [GP] job is quite unsatisfactory,” Levinson says. “I actually think they would been happy with less [money] and more patient connection. Doctors miss it.”