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Saturday, September 25, 2021

The NHS is broken – GPs know it and the patients are suffering the consequences

Two contrasting statistics exemplify Britain’s dysfunctional relationship with the NHS. Marketeers say it is Britain’s strongest brand, its workers trusted as no others. And yet yesterday a new survey found that around a quarter of patients felt they had to fight for treatment, or to be taken seriously, with more than a fifth forced to go private to get care.

Nowhere else would such poor customer service be rewarded with such glowing customer reviews.

Video contributions to the survey are shocking; witness statements testifying to often awful, basic mistakes which in turn have led to lasting illness, impoverishment or anger. As for free at the point of care? Listen to the woman who considered taking her own life while she waited and waited for an operation, and eventually remortgaged her house to pay for private surgery. No wonder Spire, Britain’s second-biggest private healthcare provider, has just announced record revenues from such uninsured self-funders.

Yet the starkest gap between how we want the NHS to be and how it actually is comes in general practice. It is in this aspect of the nation’s health provision, found a recent poll for The Patients Association, that most Britons have struggled to access care. Before the pandemic, a quarter said they found it hard to see a GP. By April this year, that had risen by half to 36 per cent – worse than for any other NHS service. And now, a survey conducted over the summer reveals, it has jumped again, with 52 per cent finding it hard to get a GP appointment. “GPs are the front door to the NHS,” notes The Patients Association, “and patients are increasingly perceiving that that door is closed to them.”

The impact is very real. Some 56 per cent of patients admit to putting off appointments, and more than half also expect their health to suffer as a result of changes to provision during the pandemic. The toll may already be emerging. For the last 18 months the number of so-called “excess deaths” in private homes has remained stubbornly above the five-year average. The latest figures, for the week to August 27, reveal that some 724 people more than usual died at home – a staggering 32.5 per cent above the norm. A single coroner in Manchester alone has linked five deaths to information that may have been missed through the lack of face-to-face consultations. Some former GPs and their families find the situation appalling. One GP’s widow, now waiting months for a painful procedure, recalls the many nights her husband spent on call caring for cancer patients. When he was dying of the same disease, “the GP practice never showed up at all – how times have changed!”

When they can get through the door, patients report often being met with suspicion. Despite statistics proving patient reticence, some surgeries have taken to posting letters on their websites bemoaning those whose “first port of call is always the GP, often requesting urgent attention”. Yet that attention can sometimes be critical, as with the 87-year-old patient fobbed off with an appointment for two days later, who went to A&E and immediately had a life-saving intervention. “He will never trust his GP again,” notes his son.

According to the UK charity, Healthwatch, which produced a report on access to primary care earlier this year, patient problems with GPs fall into four broad categories. The first is the fog of miscommunication about changing protocols for contacting a surgery in the first place, of being bounced from reception to e-consult, and back again.

The second is access to appointments themselves. GPs are the gatekeepers to NHS care, with the power to refer patients – or not – to specialist consultations and diagnostic tests. Now, however, some patients feel that receptionists or healthcare assistants are the gatekeepers to GPs. Universal triage, which was originally introduced, according to Government regulations, “to enable early recognition of Covid cases” has now become entrenched. 

As Dr Jon Griffiths, a GP in Cheshire, notes in a blog entitled What are GPs actually doing? that, while similar systems existed pre-Covid, “most GPs have continued with the practice of phone calls first… This is why you cannot, in most places, directly book a GP surgery appointment like you used to.” Some disgruntled patients have even taken to calling triage receptionists “Rottweilers” who stand between them and their GPs. Others have bundles of horror stories: triage which failed to pick up on strokes, or strangulated hernias.

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