The first inkling that GPs were to be cast out from the aura of approbation that has surrounded the NHS since the onset of the pandemic was the publication in the summer in the Daily Mail and the Daily Telegraph of articles that accused us of “hiding” from patients, and “failing” or even “refusing” to provide adequate care. These campaigns illustrate brilliantly the value of a straw man. With startling rapidity, the face-to face appointment has become a byword for accessibility and quality in primary care. Even the properly journalistic investigations into NHS general practice subsequently conducted by other newspapers and the broadcast media have been dominated by this populist metric.
A glimpse of reality came on 15 October from the healthcare company Salvie Ltd. For the past ten years it has been rolling out a remote triage tool called askmyGP in the NHS. Practices utilising askmyGP now serve more than two million people and receive 140,000 patient contacts every week. Each patient is asked what response they would like from their GP: generally, around half request a telephone call, a third a message or text, and 10 per cent a face-to-face appointment. Interestingly, around 13 per cent ultimately get a face-to-face – GPs are bringing into surgery patients who didn’t originally want to come, usually because they require physical examination or they need investigations such as blood tests.
The Health Secretary, Sajid Javid, has endorsed the use of “hit squads” in supposedly “underperforming” practices (identified in an NHS report as those holding less than 20 per cent of appointments face-to-face). My own practice will be perilously close to being sat on his naughty step. Our remote triage service earmarks 30 per cent of our appointments for face-to-face but only three-quarters of these get taken up. The majority of our patients prefer to deal with things on the phone wherever possible, as shown by a satisfaction survey we conducted during the summer.
There are certainly patients who are struggling to access primary care. Working for my local out-of-hours service, which covers a population of one million across three counties, I regularly hear stories of frenetic morning phone scrambles only to find there are no appointments left when patients finally get through. These practices aren’t “hiding”, or “refusing” to care. They are located in beleaguered areas where the GP recruitment and retention crisis has long surpassed the level of emergency. The national average number of patients per GP now stands at 2,000 – up 5 per cent on 2015 – but that disguises huge variation. A colleague in a deprived coastal community is one of only three doctors remaining in a practice trying to look after 15,000 patients. They have been trying to recruit for years; they can rarely even get short-term locums. There is no magic doctor tree.
The biggest driver of the crisis is austerity. Funding for the NHS has been progressively squeezed in real terms since 2010 and general practice has been one of the hardest hit areas. In addition, the method for calculating resources for individual practices – the Carr-Hill formula – has long been recognised as flawed, failing to allocate sufficient funding to surgeries in the most deprived communities. General practice as a whole has become steadily less attractive as a medical discipline but in the most socio-economically challenged areas Carr-Hill has driven it close to extinction.
We were promised an overhaul of Carr-Hill in 2019; it is still awaited. We were promised an additional 6,000 GPs, too; they are still awaited. Primary care was in grave difficulty back then, and the surge in workload caused by the pandemic has knocked it to the floor. Javid and Boris Johnson have hopped all too readily aboard the convenient effort by the Mail and the Telegraph to blame NHS access problems on GPs. It was ill-advised of Amanda Pritchard, the new chief executive of NHS England, to have jumped on the bandwagon alongside them.
This article appears in the 27 Oct 2021 issue of the New Statesman, Our Fragile Future