Are we expecting too much from an organisation that has its hands tied by government? In the first of a series of articles, Dr Lisa Naylor talks to Fergus Byrne about the need to support general practice.
Sometime in the early part of this year, I received a text from my local GP Surgery asking me to read a letter from an organisation called RebuildGP. It was an open letter from a group of doctors backed by the BMA and the GPDF, explaining that general practice was in crisis. The letter stressed that the crisis was not the fault of doctors or medical staff but had been caused by decades of underfunding and neglect, broken government promises, and what it described as political contempt for patients.
Whilst the story of underfunding of the NHS has been news for some time—a promise of 6,000 new doctors in 2019 hasn’t materialised and recent figures show we actually have nearly 2,000 less—it’s hard for most of us to understand the complexities involved in how our general practice is run. It’s also hard to understand how we have come to where we are now. One retired GP that I spoke to recently explained that much of the crisis was due to a ‘perfect storm’ of years of underfunding, a devastating pandemic, an aging population, and a reduction in those wanting to go into the profession.
Dr. Lisa Nayler, a Dorset GP who supports the RebuildGP initiative, now firmly believes that general practice is not safe. ‘There aren’t enough of us to provide the level of care that we want to be providing to the public’ she says. Qualifying as a GP twenty years ago she always saw her role as non-political. ‘My role has always been to care for patients. And I love my job. It’s an absolute privilege. I genuinely still now, feeling as exhausted and worried as I am, love my interaction with my patients. But we’ve got to do something about it.’ Lisa speaks for the many colleagues who are worried about what’s happening to primary care. ‘Primary care is massively important’ she says. ‘It provides the vast majority of NHS consultations. It provides the vast majority of NHS care and it’s the cornerstone of our NHS—and it’s being allowed to fail.’
Speaking about the lack of GPs since the promised 6,000 more doctors, Lisa points out how long the need has been there. ‘That was pre-pandemic’ she says. ‘The issue was already there. The pandemic has just exacerbated it’.
Lisa’s own experience, and that of seeing hospital doctors, nursing staff, Health Care Assistants and anesthetists as patients bears out RebuildGP’s point that general practice is no longer safe. ‘GPs are burning out’ she explains. ‘There are weeks where, if I saw myself as a patient I would sign myself off. And I’m not being over dramatic. The impact on family life and my mental health is massive and I am not an exception.’
The RebuildGP campaign set out with three main goals: to get the Government to deliver on its commitment of an additional 6,000 GPs in England by 2024, to tackle the factors driving GPs out of the profession, such as burnout, and to develop a plan to reduce GP workload and in turn improve patient safety.
The heartbreaking truth is that as objectives these are simply an effort to stop us from going backwards. In modern times we should be reaping the benefits of the extraordinary improvements in medicine over recent decades. Lisa points out an example of how the slowdown in procedures is causing yet more problems in GP surgeries. She cites the knock-on effect of patients waiting for hip operations and knee operations. ‘They need more primary care input because they’re waiting for their operation. So they are seeing us more which is increasing the demand for our appointments because they haven’t had their operation.’ She describes it as a ‘revolving door of patients. There’s not much I can do about them because what they need is their operation.’
There is little doubt that the call for more funding and less stress for those charged with caring for the health of the general population should be paramount in the minds of those in Government, but a better understanding of how people in the medical profession work would also help. An article in The Times recently highlighted how doctors’ income had increased because they were seeing more patients. Despite the tone being negative about doctors’ salaries, the comments section was massively supportive of the profession receiving fair compensation for their work. We all should be. A job with that level of stress deserves to be compensated.
However, there is still frustration on the ground from patients. ‘There is an expectation of a kind of Amazon Prime GP service’ says Lisa. ‘There is an expectation that the NHS can provide that kind of service. And it can’t. There’s no concept of the backroom work that goes on. I might finish seeing patients at six-thirty but I’ve got another hour and a half of paperwork to do at that stage and pathology results to look at, and they all involve important decisions.’
In 2020 we saw an outpouring of support for the NHS as people stood on balconies and applauded the work they were doing during the early stages of the pandemic. On a personal level, I was utterly overwhelmed by the dedication of the ambulance crew that visited me. I can’t say I remember or saw much of their faces but their efforts will be burned into my memory forever.
So for the many millions whose lives are struggling due to the strains and issues the medical profession is facing, and those that feel they are being pushed to borrow or use life savings to access private medical care, it’s good to see an initiative that pushes back. At a recent environmental talk I attended, the speaker suggested members of the audience should write to their MP to get help. The suggestion elicited general laughter in the room; most considered it a waste of time. RebuildGP is suggesting as many people as possible should write to their local MP to get them to help fix a creaking NHS. Perhaps that might elicit laughter too. But the key thing is, it’s better than not writing at all.