Urgent support needed for general practice

The way we all work and live our lives has changed drastically over the past 18 months due to the pandemic.

While a level of uncertainty will remain for some time to come, the pressures experienced by doctors, staff and patients in the delivery of primary care were bubbling under the surface long before any of us had heard of COVID-19.

As patient lists have increased in size in recent years, and the numbers of GPs working in Wales has continued to fall, GPs were reporting even prior to the pandemic that not all patients were able to arrange an appointment.

When the pandemic hit, and with it the introduction of social distancing measures and shielding guidance for vulnerable people, this only increased the pressure being felt by GPs and our staff. After all, while many of our regular patients are highly vulnerable to COVID-19, so are many of our older and BAME GP colleagues and staff.

Overnight we went from being able to invite dozens of patients at a time to sit and wait in our relatively small, often old, and not well-ventilated surgery waiting rooms – facilities which have been far from ideal for some considerable time – to being allowed only a small number of patients attending in person, with times staggered, due to social distancing laws and infection control protocols designed to keep us safe from the virus.

While GPs are now able to invite more patients into our waiting rooms than we were at the height of the pandemic, we are nonetheless not in a position to return to the crowded waiting rooms of old as practices continue to adhere to the latest infection control guidance. It is also still a legal requirement for face covering to be worn in indoor public areas.

The only way we will be able to safely invite more patients back into our waiting rooms is through an injection of funding from Welsh Government to significantly upgrade our facilities to a standard where patients and staff are able to attend in greater numbers and remain safe.

Throughout the pandemic however, we have been able to continue to carry out patient consultations through a blended approach. This sees those patients needing a face-to-face appointment – after an assessment of clinical need – being seen by a GP, while those that can be helped via other means being met initially via either online or telephone consultations.

Unlike has been suggested by some commentators, GP practices have remained open for patient consultations throughout the pandemic- something we have ensured is made clear to Welsh Government, Members of the Senedd, and the media. However, with demand to see a GP now vastly outstripping capacity, it is unlikely that GPs will be able to offer a timely face-to-face appointment for everyone who asks for one, even at this stage.

Technology has meant GPs have been able to see higher numbers of patients than we would otherwise have been able to during this period. Additionally, those clinically vulnerable patients have still been able to safely access their GP, while those clinically vulnerable GPs and staff have also been able to continue to carry out patient consultations.

Our experiences are backed up by the Board of Community Health Councils in Wales who reported that being able to get health care advice in different ways is easier and more convenient for many patients and that they would like these new styles of working continue into the future instead of going back to more traditional ways of working. (1)

This way of working has been supported and encouraged by Welsh Government and NHS Wales through their ‘Help us Help You’ campaign, which has seen an infographic (2) produced to help advise patients about how their initially contact with a GP surgery will be handled, through to when and how they will see a GP or other specialist depending on their individual needs.

Managing patient’s expectations throughout the process of them contacting their GP is critical, as without a full understanding and reassurance that they will get the service they need, patients and their families will rightly become nervous and concerned. Consequently, doctors have reported to us a growing trend across the UK of threats, violence and abuse towards healthcare workers. This should not, and will not, be tolerated.

The role remote consultations can play in the future as part of a suite of ways patients access their GP has also been recognised by our politicians in Wales. While the First Minister Mark Drakeford confirming that it is a “very good thing” that remote consultations are here to stay, (3) political parties themselves set out commitments in their recent Senedd election manifestos to embrace new ways of working, such as online appointments and the roll-out of new digital technologies, to make it easier to see a GP and access treatments (4,5,6,7).

We must remember however that GPs are not the only health professionals that can help patients in the community. For example, both community pharmacists, physiotherapists and occupational therapists all play important roles in diagnosing, managing conditions, and reablement. The First Minister said recently that GPs should only see patients that need the level of skill and qualification that a GP possesses (8) – he is absolutely right.

While such comments from leaders are welcome, they must be backed up by action.

Welsh Government launched their ‘Help Us Help You’ campaign in July with a flowchart and video (9) however it must not stop there as it is crucial that these messages are communicated to patients and their families to encourage them to make informed decisions about which healthcare service is appropriate for different injuries and illnesses. If communicated effectively this could have a significant benefit by reducing the unprecedented pressures being experienced by GPs at this time and ensuring that patients get timely and appropriate support.

Only 10% of people said they had heard of Welsh Government’s previous ‘Choose Well’ campaign back in 2018 (10). Significantly more investment will be needed from Welsh Government to ensure that ‘Help Us Help You’ has the impact that is needed.

Actions to (i) support patients to access the right type of professional support, to (ii) invest in our primary care facilities to make them fit for the future, and to (iii) introduce new technology to not only continue to improve access to GP consultations but ensure primary and secondary care can communicate with each other to manage patient referrals for treatment and diagnosis, will all help ensure that patients are supported, waiting lists are reduced, and begin to relieve the ever increasing pressure on GPs and their staff.

However, above all else, we must see further investment in our workforce.

More and more doctors are experiencing stress and burnout and they are telling us that they are therefore considering leaving the profession early.(11)

Only when Wales is training and recruiting significantly more GPs than those leaving the profession will Welsh Government be able to ensure more patients can access their GP in a timely manner to get the support they need.

Phil White is chair of the BMA Welsh GPs committee