As part of our series on the state of the NHS, chairman of the Norfolk and Waveney Local Medical Committee, Dr Tim Morton, talks about face-to-face GP appointments and what can be done to ease the crisis facing the NHS.
How do you respond to the health secretary’s plan to name and shame clinics which take too few face-to-face appointments?
There seems to be no end in sight for this preoccupation with face-to-face appointments.
The stark reality is that demand meets supply. If everyone was granted a ten minute consultation the system would collapse within a day and waiting times would be listed in months.
And since general practice is the bedrock of the NHS, if general practice collapses the NHS collapses this winter.
Are we ever going to get back to seeing 80 per cent face-to-face appointments?
What the profession has been moving towards - even before the pandemic - is the use of telephone triage to identify those most in need - those with possible cancer symptoms, with mental health issues, and other more serious health needs.
Wouldn’t you get a more accurate diagnosis in person?
I would say a doctor would be more likely to miss a significant diagnosis if they had no contact with the patient in the first place, if patients weren’t able to contact the service, which is likely to happen if there’s a free for all with open face-to-face consultations.
So the choice is between inadequate care and non-existent care?
Unfortunately this exposes the huge workforce deficit within the NHS. We’ve lost a significant number of GPs, we’re now over 1,000 GPs fewer than when the government promised us an extra 5,000 GPs in 2015.
So rather than going on the traditional way, over the last five years we’ve adapted. We are still seeing patients face-to-face, that has not changed, but it means we focus our precious face-to-face appointments on those most clinically in need.
We’re dealing with more patient contacts than we were last year, or before the pandemic, on a reduced workforce.
What is your workload?
In my practice this Monday we took 700 calls. Those patients are first of all assessed by our care navigators, who were formerly called receptionists but they’ve had further training. And they sift through the calls to sift out those calls which shout alarm bells - which require immediate same day further assessment.
Wouldn’t a doctor be better?
They are not making diagnoses, they’re picking up red flag symptoms which require prioritisation. They’re not bumping anyone down, they’re bumping some up.
Their skill set is immense and I have utmost pride in the skills of my care navigators, they do an absolutely amazing job.
The obsession with face-to-face has diverted people from the real discussion of having an adequate workforce.
So we have dramatically fewer doctors than we need?
Oh yes. We have far fewer GPs per population than Spain, Italy, France, Germany.
[According to OECD.org which tracks data from developed countries, Germany has 4.5 doctors per 1000 head of population, Spain 4.4, Italy 4.0, and France 3.4,. The UK has 3.0.]
Why is it so bad?
Because we’ve not invested in doctor training for many years. The GP speciality has become toxic because of this continued scapegoating of us as the villains rather than the heroes of the NHS.
That’s social media, politicians, and the media. It’s focused on face-to-face consultations rather than the real questions of do we have an adequate workforce? Has the government properly invested in general practice? Do patients realise the huge amount of work that goes on in general practice?
Most surveys show people welcome the move to telephone triage. What you hear is a minority of people who either have an axe to grind or are unhappy for some reason. The vast majority of our patients just want to access us, whether by telephone triage or face-to-face.
Given the constraints of the workforce I think we do an incredible job and I’m very proud of my colleagues across Norfolk who do that.
What does a GP earn?
An NHS consultant in a hospital will be on about £100,000, a senior GP will be on about the same. What we’ve seen in the last year is the pay of GPs has gone up because we’ve been doing excessive overtime to support the pandemic on top of a depleted workforce.
Given the amount of responsibility that we undertake, I think we get paid a fair wage. We take considerable risks on our shoulders on a day to day basis.
I’d ask if we are so well paid and the job is so lovely, why are we facing such a recruitment problem? It’s not about the money. It’s about workload pressures.
It’s about a complaint culture that we have in this country. Unless the population acknowledges that and supports their NHS staff in hospitals, in mental health, in ambulances, in dentistry, or in general practice, we’re facing a bleak future.
So it’s our fault? It’s down to the public?
It’s down to the public and politicians and media - to be kinder and respectful and nicer to everyone.
Read our whole series: NHS On The Brink
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Hospital saw just one breast cancer patient on time
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The crisis in the region's ambulance service
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