Real reason why your GP won’t see you now
WHEN will GPS go back to working normally again? By normal, I mean seeing their patients in the flesh, looking in ears and down throats, palpating stomachs, examining lumps, manipulating limbs, these and all the procedures previously taken as part of a face-to-face appointment.
Dentists have been back in their surgeries, staring into their patients’ mouths for months, catching up with a backlog of painful tooth trauma from the first lockdown.
Physiotherapists and osteopaths are seeing people flat out. You can have your eyebrows waxed and your toes manicured or have your hair done.
M&S will even fit a bra for you but GPS still won’t routinely encounter their patients in the flesh.
If you don’t slam the phone down in frustration, or collapse on the spot after 15 minutes’ wait on the phone whilst selfrighteous ‘due to pandemic’ messages bleat in your ear – is this chest pain I’m experiencing a heart attack or rage? – a receptionist-gatekeeper will eventually offer you a telephone appointment.
Those who belong to the digitally-competent generations might be asked to take a picture of that throbbing boil on their right shoulder with their left hand then forward it to the doctor. A screen consultation might be on offer.
But much of the time, only those patients who, by accident or design, utter phrases that trigger medical alarm – “My baby won’t feed and seems sleepy all the time” – make it over the surgery threshold.
So what, exactly, is the current official status of the service provided by GPS?
Still Code Red for emergency? Is that the excuse?
The BMA’S Covid-19 toolkit tells doctors that “practices have a responsibility to provide services to your registered patients”, and points out that “Covid-19 does not in any way negate this requirement”.
Bless you for that statement of clarity. But, then comes the wiggle room. GPS should continue to provide routine care “in the way that they decide is clinically appropriate”.
So is this the key to why some GPS are still managing to see more of their patients face-to-face than others: a difference of clinical judgement?
Or does ideology come into it, too? An aggressive agenda pushing the virtualisation of primary healthcare was made overt last July when Westminster Health Minister Matt Hancock, an enthusiast of “telemedicine” or “Zoom medicine” on video calls announced that initial GP appointments should move online unless absolutely necessary.
He stressed that GPS “must not fall back into bad habits” once the pandemic ends. There you have it. Face-to-face GP appointments are bad habits.
Since then Hancock has ordained that following the pandemic, 45% of GPS’ consultations should be carried out remotely. Before Covid, around eight out of 10 GP appointments were conducted in person.
The prospects of seeing your GP get slimmer still because the UK Government plans to embed a “total triage” model in general practice in England beyond the pandemic.
Similar ambitions seem likely to emerge in Scotland.
Total triage means that you won’t be able to book an appointment with your practice directly. Instead, following a “digital first” principle, you’ll need to use “automated tools” – a website or an app. What joy for all the elderly and infirm that will be.
Hancock informed the Royal College of Physicians that it was time to “bust bureaucracy” by removing the “barnacles” hindering the health service.
Feel worried when you hear that? I do. It’s code for “Let’s make it difficult for any ordinary person to see a GP. That’ll either kill them off or make them stump up for private medicine.”
Meanwhile, the consequences of GP surgeries restricting real life consultations are apparent. People are dying.
A family friend phones her surgery because her husband is in agony with stomach pains. She’s told to give him painkillers. She phones the GP again as his condition worsens and is told to dial 111.
Eventually an ambulance arrives, but he dies within hours of arriving at hospital.
Through her grief she has managed to lodge an official complaint that will be judged – by whom? – a board of GPS. She has given up now.
An A&E consultant tells me that he’s been crazily busy. With Covid cases? With more rowdy weekend punch-ups outside pubs as restrictions on alcohol are eased?
No, he and his colleagues have their hands full dealing with lots of old people with complex medical problems that have worsened over the last year, yet they have been unable to get the attention they needed from their GPS.
Last week, hospital cancer specialist Dr Karol Sikora summed up the limits of “remote” medicine. “Seeing a patient over a video link is sometimes sufficient, but we should not be looking to make that the default option.
I’ve held tens of thousands of appointments with patients. It needs to be done in-person, over a grainy camera link is just not good enough.”
Is such sentiment merely a nostalgic hankering for the good old days, when you could almost always see a doctor, and one might even – if you can you credit it now – visit you at home?
I’ll admit that deep down I want my GP to be Dr Turner in Call The Midwife. Abreast with scientific developments, he was empathic, never cynical, always focused on his patients’ welfare.
He was also a passionate believer in the NHS because it gave free access to health care for the poor communities he served. His receptionist was firm yet kindly. She used her brain and judgement when fielding the public, not some ‘smart healthcare’ algorithm.
It was encouraging this week to hear the Royal College of GPS stress that faceto-face consulting is “an essential element of general practice” and reiterate Professor Sikora’s view that remote consulting should be an option but not the “automatic default” post-pandemic.
We desperately need our doctors to stick up for their patients, and that means seeing them in the flesh.
They must not stand silent when a butchered GP service is sold to us as a digital marvel.
Matt Hancock has ordained that 45% of GPS’ consultations should be carried out digitally once the pandemic is over