Dr Peter Moore: Blaming GPs is the same as blaming the ship's captain for the storm

Torbay Weekly

Just before Christmas an 85-year-old lady called out her GP. She was anxious and finding it difficult to stay at home.

The GP knew he should spend time talking it through and offering help but had two distressed palliative care patients, a patient with a possible blood clot in the lung, a likely case of sepsis from a kidney infection, a patient with possible bowel obstruction refusing admission to hospital and a suicidal patient who the practice could not reach by phone.

All he could do was to give her the phone number for social services.

General Practice should be so much more than crisis management, but today’s GPs just have to survive.

There is no time to delve into the ideas, concerns and expectations of patients.

A colleague said he had to become an 'emotionless machine'. One practice told me demand is 31 per cent higher than before the pandemic.

A face-to-face consultation takes as long as three phone calls. On a normal day GPs often deal with over 80 telephone consultations, sign 150 prescriptions, look at 50 lab results and read 50 letters from the hospital, as well as seeing patients.

Every one of these letters, phone calls, prescriptions or lab results could be vital for someone’s health.

Could there be the early warning signs of cancer buried among the deluge?

Patients understandably become angry, unfairly blame GPs and abuse the practice team.

The only way to cope is to start work very early, work into the evening and catch up with paperwork at nights and weekends.

The whole situation is exacerbated by the media implying GPs are on the golf course.

How many people realise that the highly efficient vaccination centres are largely run by general practice?

Why is the NHS facing this crisis?

Covid is only partially to blame. Before the pandemic the NHS was on a knife edge.

The UK has less intensive care beds than most other European nations with 10.5 per 100,000 population compared with 33.9 in Germany and 16.3 in France.

In 2017, the British Medical Journal published figures to shown that Austria has 5.1 doctors for every 1,000 people, Germany, Italy, Lithuania, Norway and Switzerland have over four while the UK has only 2.8.

In Torbay, we have some specific problems.

Between 2004 and 2020, the population increased by nearly 17 per cent.

Between 2020 and 2030, the council estimate another 6.1 per cent rise.

The number of GPs has not kept up.

Torbay is ranked the most deprived local authority in the South West with one of the highest level of domestic violence in the country and levels of alcohol abuse and mental ill health above the national average.

This tsunami hit GPs when they were already facing serious problems.

GPs are self-employed, running their own practice.

In the old model a new GP partner would take out a large loan to buy into the practice, stay for 30 years and be bought out when they retire.

That worked in 1948 but the world has changed.

Many new GPs do not want to buy into a partnership. They already have a large student loan and do not want a long-term commitment.

As a result, GPs practices cannot recruit new doctors. One local practice has only three partners serving over 16,000 patients.

If the practice team self-isolate due to Covid the situation becomes worse.

As the pressures increase, some doctors leave general practice increasing the pressures on those left behind.

Practices are increasingly using paramedics, pharmacists and nurses to take calls but they need support from the GP.

As the job becomes increasingly stressful so very few young doctors opt for a career in general practice.

I wish I could provide a glib solution but all I can say is that GPs and their teams are fighting hard against incredible pressures.

Blaming the GP for the service is like blaming the captain of the ship for the storm.

They are dealing with a situation which is no longer sustainable.

All they can do is to try to avoid sinking.