Health bosses fear a mass exodus of GPs and their staff, with abuse from frustrated patients, growing demand and controversy around virtual appointments leaving clinicians "demoralised" and under "insurmountable pressure".
The sector is under huge stress as it copes with the ongoing impact of the pandemic, with hundreds of thousands of people across Norfolk and Waveney seeking help from their GPs each month, with many struggling to make appointments and enduring long waits.
This has led to some patients taking out their frustrations on GPs and their reception staff.
Melanie Craig, chief executive of the Norfolk and Waveney Clinical Commissioning Group (CCG), warned that the conditions risked driving many clinicians and their support staff out of the sector, thus exacerbating the crisis.
In a report to the CCG's board, she wrote: "I think there is a real risk the situation will mean clinicians and other staff leave general practice, so we need to do all we can to support them."
She identified abuse as a particularly significant factor in driving out GPs and their staff.
"The demanding workload, coupled with the abuse staff are receiving from a small number of patients, is making general practice a less attractive place to work, risking making GPs and practice staff harder to recruit, and causing existing staff to retire early, choose to work elsewhere in the NHS or leave the health service completely," she wrote.
One area of controversy is the use of virtual - rather than face-to-face - appointments, which increased hugely during the pandemic and is still widely used.
The proportion of face-to-face appointments in this region is actually higher than the national average, with 70pc taking place in person, compared with 61pc in the rest of the country.
Clinicians - and some patients - argue that in some circumstances, a phone or video call can be the best option. However, it remains a contentious issue, and one that prompts frustration from many patients.
Tim Morton, chairman of the Norfolk and Waveney Local Medical Committee and a GP in Beccles, explained some of the issues facing family doctors.
"The pressure is insurmountable," he said. "It is far beyond pre-pandemic levels for a variety of reasons - there is still a lot of Covid around but fewer of the people with it are requiring hospital treatment. We are also in respirational virus season and have an old, frail population so lots of them need our help too.
"We are also giving out Covid and flu vaccines so it is just generally a really, really busy time for us and it is coming from all directions."
He added: "We are all trying to do our level best but there is only so much anyone can take."
He said it was difficult to find a solution to the issue of retaining existing staff, with the process of new GPs qualifying a lengthy one, given the level of training that is required.
He added: "It is not easy but it is all about having patience and respect, and that goes for everybody. It is too easy to knock people, but we are trying our level best."
Nick Morton, senior GP at Bowthorpe Medical Practice, said: "On Monday I got into work at 8am, did not leave until 7pm and probably stopped for about 20 minutes for a sandwich. The suggestion that GPs work from nine to five is just wrong.
"My patients wouldn't dare abuse me, but it is not just GPs, it is the whole staff that are affected, particularly young and female receptionists that people think it is acceptable to shout at, swear and generally make their lives awful.
"When you hear the kinds of things politicians say, read national newspaper headlines and receive abuse from that very small minority of patients it is just demoralising.
"There are lots of older GPs still around that might decide it isn't worth it anymore and if we start losing them we've got a really big problem."
According to the most recent figures available, in September more than half a million GP appointments were honoured in Norfolk and Waveney - 559,935 in total - 392,876 of which were face-to-face.
In August there were 482,993 appointments, compared with 478,160 in August 2019, demonstrating that demand for GP appointments are exceeding pre-pandemic levels.
Calls for patient experiences
The impact of Covid-19 has brought about wholesale changes in the way GP surgeries communicate - with greater use of digital communication and virtual appointments.
This has prompted Heathwatch Norfolk to launch a survey that aims to assess how patients are finding their experiences of virtual appointments and the way digital communications are used.
Alex Steward, Healthwatch Norfolk chief executive, said: "Having a range of digital ways to contact the team at your surgery has taken time to adjust to and we are keen to find out how that experience has been - both good and bad.
"The experience of patients, carers and relatives will help to develop and improve the digital technology connecting us to our survey."
To participate in the survey, which takes around 10 minutes, visit https://www.smartsurvey.co.uk/s/digitaltoolspublic/
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