15 Feb 2024
Laura Bill looks at the demands we place on local GP services, and what they can do to make the experience better…
The absolute last thing anybody wants when they have to crawl downstairs to the bathroom, feel like they are being stabbed in the sinus or have worrying chest pains is a telephone battle.
Press one for classical music you’ve heard ninety-three times in the last year, press two for the most miserable and fast-talking woman you’ve ever heard in your life, press three to be told to call back after 2pm for blood test results, press four if by now you just want to go back to bed and die quietly.
You are number eleven in the queue. Brilliant.
The amount of times you end up hanging up before speaking to a human has likely to have outweighed the sensitive and timely medical advice or care that you were seeking.
If you do hold on and then get an appointment to be called “sometime today” or the like you then ideally spend the rest of your sick day staring at your phone wide awake for when it rings.
This means you can’t relax fully because if you miss the call you’ll get another one in quick succession and then a voicemail or text telling you to start the whole bastard process again.
Oh, what has happened to our beloved NHS?
When I moan about these types of very frustrating and other inadequate situations, I spot two types of responses.
The ones like mine or the ones who are gracious and protective, and might say something about how much worse it is in other countries who aren’t lucky like we are or that they think everybody is just doing their best and we should be kind to them.
One St Albans patient, who wishes to remain anonymous for fear of repercussions, said: “My surgery has moved over to a triage system,
which I suspect will direct you down a root to just one issue. In many cases that will work.
“However I suspect for those who have several conditions, possibly mostly older patients that just won’t do.
“I hear if you have a child that is ill you are given an appointment straight away offering either by phone or in person, yet for the rest of us it’s pot luck.”
Another patient said: “I feel so much for the elderly people who possibly have no one to support them and argue their case for an appointment.
“Some concerns can be discussed by telephone, but they never give you a time to call so what if you’re at work or travelling and not able to answer?
“We’re quite rightly told to be polite, but it would be nice if it was reciprocated by some receptionists. We’re too scared to share our experiences in case we’re removed from doctor’s lists and branded as troublemakers.”
The St Albans Times wanted to give GP surgeries the chance to tell us the challenges they are facing and what could be done to improve the situation. We emailed the practice manager at The Maltings Surgery, The Lodge Surgery and Parkbury House the following basic questions:
- Why are GP receptionists so busy?
- Why are patients on hold on the telephone for (sometimes) hours?
- Do you have enough GPs and receptionists? Why do you think that is?
- What could be done by our Government to help you?
- How are your patients feeling generally about the service they receive?
We didn’t call because we didn’t have a spare four hours to sit in the queue and try to get through to someone human. But after two weeks of waiting around, we realised nobody was going to reply, not even to politely acknowledge our inquiry and steer us in the direction of someone who could answer.
This could have been a perfect platform for our local GP surgeries to explain the ongoing pressures they are under, to appeal for public sympathy and to get us on side. But they chose to ignore us.
So we approached St Albans MP Daisy Cooper, who is also the Liberal Democrats’ national spokesperson on health, and asked her what she thought of the triage system, especially with more and more people failing to access the appointments and services they need.
“It’s really important for patients that GP surgeries can and do triage. It’s a vital tool in ensuring that everyone gets the care they need as quickly as they need it,” Daisy explained.
“Based on a patient’s reported symptoms, GPs may want to immediately refer patients for a scan or specialised tests without needing to see the patient face-to-face.
“In other cases, GPs will be able to redirect patients to a local pharmacy, which provides valuable and easy-to-access walk-in high street health care.”
Daisy said that triaging frees up millions of hours of time so that GPs and their professional
practice staff can spend the time they need with patients who need a face-to-face appointment.
She explained if patients can’t access their GP, some give up on trying to get an appointment and wait until their symptoms deteriorate so much that they end up in A&E.
Referring to this as “bad for patients and bad for the tax-payer”, Daisy added that she believes solving the GP access crisis is critical in order to help people get early diagnosis and treatment and save the NHS from “buckling”.
Her party wants all patients to be able to have an appointment with their GP (or the most appropriate practice professional) within seven days, or within 24 hours when needed, and also have access to a 24/7 booking system.
On the pressure put on doctor’s receptionists she said: “People are really struggling right now. Even when you’re feeling grotty and you’re struggling to get the help you need, there is absolutely no excuse for rude or bullying behaviour.”
Daisy said she has seen receptionists bearing the brunt of patients’ aggression, or even abuse and thinks it is important to take a zero-tolerance approach to such behaviour.
She said: “I think a good principle for all of us to live by is that we should never abuse the people who actually turn up to do the job.”
Asked about the effectiveness of online appointments, she stressed: “The best type of appointment depends entirely on the individual needs of the patient. A busy person with an easy to diagnose issue may benefit from an online appointment.
“Those with caring responsibilities or who fall ill when they are away from home, may at times only be able to access their GP in this way making it ’better than nothing’.
“There are also those who want a face-to-face appointment because they are not comfortable using digital tools, or whose issue requires a physical examination.”
She pointed out that not all patients have a safe space to access online health advice, for example a person living in an abusive relationship, so flexibility in appointments and listening to patients should be the norm.
The Liberal Democrats are calling for patients who are 70 and over and those with long-term conditions to be able to have guaranteed access to their named GP or specialist member of staff – whether that’s online or in person – so these patients can access the vital continuity of care that they need I asked Daisy if she knows why there are so few full-time GPs. She explained that GPs have told her of the immense workload they are dealing with and that is a key factor in their decision to not work full-time.
Some in the profession believe that it’s only safe for GPs to hold 25-30 appointments a day, but Daisy knows that some GPs routinely hold up to 80 a day which she said is potentially putting patient safety at risk.
She said: “GPs may have their own health or caring responsibilities to manage – whether that’s for children, elderly relatives or others – and we should be supporting those who do want to work part-time to work the number of hours they feel they are able to.
“At the same time, it is generally widely accepted in other areas of medicine that a professional’s time will be split between treating patients and for example, engaging in further research and training to improve the care they can provide. This kind of activity really benefits patients and their care so we need to ensure that GPs are able to take these opportunities too.”
She said that we need more GPs adding that there are now fewer full time equivalent GPs in England than there were in 2015. England has just 7.8 GPs per 10,000 people, compared to the OECD average of 10.8.
Finally, we discussed accessibility for people with disabilities and/or older adults.
“Analysis shows that when choice is offered the vast majority of people will opt for using online booking systems.
“However, we must always be wary of digital exclusion and ensure that the option to call, or indeed pop in in person, remains for those patients who need it.”
Daisy said that as a priority, the next government – whatever it looks like – will need to get a grip on the “prevention agenda” and start to see the money we spend on improving primary care – like access to GPs and dentists – as an investment that saves money down the line.
“It’s simply absurd that at a time when we have an ageing population and more and more people with complex health needs, we are spending a smaller percentage of the overall NHS budget on primary care than ever. All this does is lead to people going to A&E because they can’t access the care they need, costing the taxpayer more.
“We need to fix the front door to the NHS by improving access to GPs, dentists and mental health practitioners, and fix the back door to the NHS by tackling social care if we are ever to break this pattern.”
