“It was alright as long as you didn’t get ill”.
My step-grandfather used to say this to me when reminiscing about life growing up in the Welsh valleys in the 1930s. Pre-war Britain could be a cruel place, especially if you were from a poor family (which he was). It could be crueller still if you had the bad luck to be poor and sick – a cursed combination. A visit to the doctor could set you back half a week’s wages.
We have come a long way as a country since then. We have the NHS for starters, founded by the former Labour health secretary, Aneurin Bevan, who grew up in Tredegar, a few miles down the road from where my grandfather lived. Yet today, in pandemic Britain, access to adequate healthcare feels once again out of reach to many who fall ill.
Anecdotes about the difficulty of getting a doctor’s appointment in 2021 are ubiquitous. You phone up your local surgery and wait on hold for half an hour. You are told to call back at 8 o’clock the next morning; then the process begins all over again. If you manage to get through to a receptionist, you are sometimes told that a face-to-face appointment is unavailable. Instead, the doctor will call you back, perhaps in a week’s time. At what time, you ask? We can’t guarantee a specific time, comes the reply.
This was my own recent experience. For the more assertive among us it’s usually possible (eventually) to navigate the Kafkaesque booking system and obtain an appointment. But many simply give up. The most recent GP People Survey found that 42 per cent of people have avoided making a GP appointment in the past 12 months.
The government’s national Covid policy last year instructed GPs to conduct appointments remotely. Switching back is proving a challenge: in August, just 58 per cent of appointments were conducted face-to-face, compared to a pre-pandemic figure of 80 per cent. In light of this, certain media outlets have been campaigning for more face-to-face GP appointments. The corresponding stories have frequently been coloured by depictions of GPs as lazy, entitled and obstinately uncooperative. “GPs still ignoring orders to allow patients face-to-face appointments”, boomed a recent headline in the Daily Telegraph. The Spectator has accused doctors of “hiding behind Zoom screens”. The Health Secretary, Sajid Javid, responded to the negative press coverage by announcing “league tables and hit squads for those that fail” to offer face-to-face appointments.
Healthcare workers have frequently been on the receiving end of public ire during the pandemic. We “clapped” for NHS staff last year, but since then many NHS workers have had to endure verbal abuse from Covid deniers and anti-vaxxers, including comparisons to Nazi war criminals. Others have been spat at and subjected to physical violence: in November a member of staff at Lewisham University Hospital was stabbed by a patient. A hospital in Norfolk has even stationed private security at its main entrance overnight following increasing incidents of “rude and abusive behaviour” against staff.
Is it any wonder some GPs are reluctant to return to giving in-person consultations amidst a climate of such animosity? Another recent survey found that more than half (51 per cent) of GPs experienced abuse in the month of July this year.
Of course, it’s easy to rail at doctors when you’ve just wasted an hour on the phone only to be informed that, regrettably, there are no appointments. I know because I’ve felt this emotion welling up inside me too. If it really is “our NHS” – as the mawkish slogan has it – then why does getting a GP appointment feel like such a big ask?
Yet the fault probably doesn’t lie with your local doctor. The health service is dealing with record numbers of patients and there simply aren’t enough GPs to take up the slack. It is this simple equation – rather than the purported indolence of GPs – that is causing patient frustrations.
The previous government acknowledged as much back in 2015 when it promised to hire 5,000 extra GPs within five years – a target it subsequently failed to meet. Indeed, a recent analysis by Sky News found that the number of fully qualified GPs had fallen in four out of five areas of England since March 2016. In the lead up to the 2019 General Election, the then health secretary, Matt Hancock, acknowledged this; the incoming government sought to cushion the failure with a fresh pledge to recruit 6,000 GPs by 2025.
This too has failed to materialise. According to the Royal College of GPs, the number of practicing GPs fell by 1,307 to 28,096 between September 2015 and March 2021. As of September 2021, there were 1,704 fewer fully qualified full-time GPs compared to 2015.
Today, England requires around 50,000 extra doctors to meet the country’s health needs. At present there are just 2.8 doctors per 1,000 people, compared to 3.7 in similarly developed EU countries. Much as in the bad old days, access to healthcare is significantly worse for the poor. According to recent analysis, deprived areas have fewer GPs than wealthier ones and this gap has been widening over time.
This dwindling band of doctors is having to cater to a record number of patients. There were 4 per cent more GP sessions in 2021 than in the same period in 2019. The typical GP practice has 1,849 more patients today than six years ago and there were 7.3 million more appointments (or 3.1 million more if you exclude Covid vaccinations) in June of 2021 compared to the same period in 2019.
Unsurprisingly against this backdrop, many GPs are struggling under the pressures of increased workloads. According to a survey by the British Medical Association, nearly half of doctors said they were suffering from depression, anxiety, stress, burnout, emotional distress or another mental health condition. Some GPs are looking to exit the health service altogether, compounding the problem of staff shortages. More than one in 10 GPs questioned in a survey said they planned to leave the NHS.
More patients and fewer, increasingly frazzled, GPs: it’s easy to see why many of us are crashing up against answerphone messages when we call the local surgery. Though it might feel emotionally gratifying to take out those frustrations on doctors, our anger would be better directed elsewhere. If we have a primary care system that increasingly resembles the bad old days, it is down to the government’s longstanding failure to solve the NHS recruitment crisis.