In the past year over the Covid pandemic, we have been working longer and harder and digging deeper than ever before.
We pushed aside our fears and sidelined our own wellbeing (often that of our families too) and devoted ourselves to overhauling the structure of healthcare provision to meet the needs of our people.
We lost colleagues along the way, family members, friends, patients we cared for deeply. We contracted covid ourselves. We worked through the hell with acceptance and grace about the part we needed to play and the risks of being on the frontline. Like all the patients we compassionately treat, we too are exhausted and traumatised.
The undertaking of the past year has involved twelve hour work days - tireless and selfless commitment of GPs throughout the country to bring about safe and appropriate care.
It has been a complex operation of collaboration, creativity and digital innovation. We now have an armoury of telephone and video consultations and face to face assessment where clinically indicated, mostly on the day or within the week. In fact we have made general practice so accessible that we are drowning under the weight of demand. The work days no longer seem manageable. GPs go home exhausted and dejected and wonder how they will cope with the next day, let alone next week or another fifteen years.
It is not just the relentless work but frequent unkindness, rudeness and often disregard for clinical judgement that is tough to bear. Most patients are considerate and grateful and remind us that our efforts are not in vain. Sadly many aren't.
Not only have we revolutionised access and continued to deliver equitable care under impossibly difficult circumstances, but we have helped pull off one of the most remarkable health endeavours of human history in the form of a mass Covid vaccination programme. There were many extraordinary contributions from people in all walks of life to make this happen and for this we are indebted, but without GPs, it would not have been possible.
So when all is said and done, we are quite baffled by the concept that general practice has at any point been closed. We are hurt by the implications that we are lazy and uncaring.
These seemingly widespread held views are miscalculated and deeply upsetting to GPs . We have all but sold our souls in our efforts to keep the ship afloat through this carnival of chaos and it seems the thanks we get is a kick in the teeth. Sadly this rhetoric is all too familiar.
The issues bothering many patients, being driven by the media seems to be the inalienable right to face to face consultations, on demand, under any circumstance, in the context of a global health pandemic.
As things stand, this is not a clinically sound, equitable or even a physically possible expectation.
If we currently offered everyone who wanted it a face to face consultation, it would come with the following implications.
We would be complicit in the knowledge that we are inscrutably bringing patients into the surgery at their request, to full waiting rooms, so creating a Petri dish for spreading covid.
We would be driven by the demand to see a doctor for a sore throat that’s been there for three hours since waking up or a patient who’s been feeling tired for three days and wants time off work or someone who needs advice about some patches on their face that aren’t tanning as well under the sun-bed. (I don’t mean to be glib but these are common themes under which the healthcare system is drowning.)
The current system of doctor triage and the use of clinical judgement to determine need, facilitating quick and appropriate face to face reviews will be replaced by six week waiting lists. With it will come even more discontent and blame and moreover it will be unsafe. The risk is delayed cancer diagnoses and complex-needs patients being buried in an overwhelmed lottery appointment system.
We would have the pleasure of being shouted at in person about the delayed hospital appointment or operation rather than just over the phone.
We would need to have clinicians consulting many more hours a day to meet demand. The logistics do not add up - we don’t have enough GPs to get the job done in the work hours available. And many like me are thinking of leaving the profession so it is unlikely things will get better.
We know things are tough for everyone right now and we are working out ways to make it better. Much of what is going on is a complex interplay of social, political and economic dynamics that go well beyond our remit or control as GPs. We are doing what we can with the limited resources available and overwhelming pressures so please be mindful not to jump on the bandwagon of scape-goating your GP.
What is happening in the NHS is not our making.
So no, we are not closed, nor have we ever been. We are open and we care and we are doing our best. Patients who are assessed as needing a face to face appointment are getting one, they always have, based on the experience and clinical acumen of clinicians.
We have some good systems in place and if anything we could do with your help.
To respect us and our clinical judgement.
To not shout at us and blame us for circumstances beyond our control.
To show us some compassion and kindness as fellow humans who have been through a lot ourselves
To help us help you by taking responsibility for self-care when you can, visiting NHS choices for helpful information and chatting to your pharmacist for advice where appropriate.
Please know every time you ask the question: When are you GPs going to open up again? it breaks us. And without us, the future of healthcare really will look bleak.
Dr Chapman, NHS GP