When strain in the country’s hospitals reaches breaking point a black alert is signalled – declaring that the safety of the public can no longer be guaranteed.
In response to a black alert – formally, known as OPEL Four (operational pressure escalation level 4) – support is mobilised and a collective response gathered; local emergency care delivery boards draw up action plans, regional NHS England teams work to find solutions and national health leaders are even asked to step up and make their mark.
But for overstretched, under-resourced GPs the everyday reality of providing care in an environment which is utterly exhausting – and even unsafe – is an altogether much more personal affair. There are not often teams of managers ready to put desperate action plans in place and GP practices are not usually large organisations where demand can be shunted from one area to another or staff transferred to ease colleagues’ woes.
Doctors at the BMA annual representative meeting in Bournemouth last week decided to support GPs – and call for a system of black alerts in general practice, a measure which could give struggling frontline staff the voice they desperately need.
Derbyshire GP Peter Holden (pictured above) – who says the crisis in general practice means he is now the oldest GP in the whole of the county, at just 60 – made the case strongly, proposing the potential new system.
‘We don’t formally measure things in general practice – and that can be our Achilles heel,’ he said.
‘Nobody takes any notice of the frequently quite impossible workloads [in general practice]. It’s not about GPs closing their surgery doors and diverting everything to a local emergency department. It’s imperative to develop a system. We as a profession need to define our own workload and define what is safe. It is time we stood up and said we are an essential arm of the NHS.’
Speaking during the debate, north London GP and BMA GPs committee chair Chaand Nagpaul (at the time of writing) said: ‘We need a system where GPs aren’t afraid to say they are under pressure – we need a system where people can hold their hands up legitimately and say they are worried about the care being given to their patients.’
The motion calling for a system of black alerts – now BMA policy – will be looked at by GPC and best options and methods assessed and discussed.
It was roundly welcomed by many at the ARM – including west Midlands GP Mary McCarthy, who told the conference a familiar story about everyday difficulties as a gatekeeper for the NHS.
‘We see, talk to, question, physically examine, arrange investigations for and discuss treatment options with at least 40 or 50 patients a day. In Australia that level would have royal colleges asking about safe decision making. In Belgium 10 a day is more typical.
‘We should be able to tell the public, as hospitals do, that we are maximum capacity and coping with further demand may not be safe. We’re not closing our doors – we just want to put up more warning signs.’
The discussion was part of a wider debate with doctors discussing the difficulties of life on the front line in primary care.
In the year since the last ARM much has happened in general practice. Despite the Government and NHS England formally recognising the crisis in general practice, and publishing a raft of measures intended to make a difference, life remains as tough as ever.
South London GP Penelope Jarrett said it felt impossible to access the support the document outlined owing to oppressive red tape.
‘The funding is incredibly complex,’ she said. ‘They’re not actually giving us money, you have to apply for it and bid for it and you may or may not get anything. There are all sorts of criteria and you have to give supporting information. Most practices just aren’t in a position to do it – it can only be done by big federations and CCGs [clinical commissioning groups]. It’s hopeless – it’s much too complicated.’
The stark picture in general practice was outlined earlier this year when research found that more than a quarter of a million patients in England were forced to move GP surgeries during 2016 – with record practice closures highlighting the crisis in general practice.
Figures showed that 254,000 patients had to move – a 150 per cent increase from 2014, with continuity of care and relationships between patients and doctors suffering.
It comes despite NHS England finding £500m for a ‘turnaround package’ in 2016, in a bid to stop practice closures.
North-east London GP Terry John said: ‘It’s an excess of workload – pure and simple. These initiatives are like a sticking plaster on a gaping wound. What we need is better investment in general practice and resources for general practice.’
Doctors at the ARM also called for immediate upgrades to resources and workforce numbers and for the BMA to create a communications work stream focused on explaining recent changes to the primary and secondary care interface within the standard hospital contract to trusts, CCGs and different branches of practice.