As a GP, often the simplest cases have a story behind them that I wasn’t expecting.
Like the patient with acne who asked for NHS treatment because they’d been made redundant and couldn’t afford to pay for it online anymore.
Or the patient with back pain who broke down about how difficult it was to get here because their partner was ill and asking if I would visit.
I’ve been a GP in the North East of England for six-and-a-half years and I genuinely love it. I try to get to know my patients to be able to paint a complete picture of their healthcare needs.
I should have more than 25 years left in my career, but I’m watching what’s going on with funding cuts in real terms and I’m needing to plan for what I’ll do in the increasingly likely scenario that NHS general practice fails.
In February, NHS England only offered a 2% annual contract uplift, which is not enough to sustain the services patients need. It means that, ultimately, when the cost of providing care is more than the funding, practices will go under.
That is why I, and my colleagues at Doctors’ Association UK (DAUK) support the industrial action overwhelmingly voted on this week by GPs.
It will take the form of collective action, which will see us choosing from a number of options, such as limiting daily patients to 25 (the recognised safe limit) and referring patients directly to specialist care rather than following more complex NHS processes.
The move has been described as ‘catastrophic’ by an NHS chief, with Health Secretary Wes Streeting asking us not to ‘punish patients’. However, this action is about patients.
If we carry on funding general practice in the manner that we are, there will not be enough GPs left.
Historically GPs have just plugged gaps in care, working above and beyond their contracts for free. NHS England and the last Government were repeatedly warned this was not sustainable.
But our calls were ignored and therefore – rather than closing our doors and striking – we are aiming to work in a safe way and take care of our patients properly, while also demonstrating to the system the sheer amount of unfunded work we have been doing.
Our leaders have clearly realised how important seeing a GP is to patients.
And in misguided desperation they have prioritised access and seeing someone quickly, over continuity of care and seeing someone who knows you.
They seem to believe that if we could split up the job of a GP into parts – the back pain to physio, the home visit to a paramedic, the lonely person to a social prescriber – then that would be just as good as a GP.
Seeing an experienced GP who knows you matters. Continuity of care matters.
Of course, the multidisciplinary team is valuable, but if we dish out the work after a one-line triage from the receptionist we will never get it right and patient satisfaction is now on the downward trend.
I think most patients want to see a GP, and are happy to wait to see the same one. In fact, patients remind me again and again that people cannot be reduced to a single issue.
GPs have been trained in recognising the biological, social and psychological causes of illness. In other words, seeing the whole picture.
We are not just a sum of all our medical problems and when we see a person as a task and not in their totality we miss what being a GP is really about.
We are unique. And we need and want to be seen, especially when we are suffering. Seeing an experienced GP who knows you matters. Continuity of care matters. The only way to achieve this is with a significant uplift to the GP contract so practices can keep their doors open.
Without these recently voted-on actions, we are hurtling towards a two-tier model similar to dentistry, where it will be a postcode lottery whether an NHS GP will be available for you at all.
Unfortunately, we already have practices handing back contracts and going bankrupt at an alarming rate. This chaotic shambles is a nightmare for patients and leaves them confused as to where to turn when unwell.
As a mum, daughter, and a GP, I’m terrified there may not help available for us when we need it.
Our funding has not kept anywhere near up with inflation, and after years of erosion we as GPs have needed to strive to provide what patients need.
Dr Lizzie Toberty is the GP Lead at Doctors’ Association UK.
When there has been a gap in provision, we have filled it for free – with long days and stress. We are exhausted.
And we know that a 30-year career in general practice is no longer possible. But this week, as a profession, we have said no more.
We have needed to implement action to protect practices.
We need to recognise seeing 25 patients a day is what is safe. Would you want to be the 40th patient of the day, when decision fatigue and the emotional drain has set in?
Our patients deserve better, and our vital role in ensuring NHS resources are used properly must be protected.
According to our own figures at DAUK, GPs have 1.3million daily patient contacts, the largest of any part of the NHS, and that includes hospital outpatient appointments (250,000), and A&E contacts (67,000) – and yet it receives just 5.6% of the NHS budget.
We urgently need investment to support our staff, our buildings and our IT.
This action is about better care for our patients, and better resourcing for our communities, our practices, and our staff.
But all is not lost. The Government can protect general practice with funding of around £35 per patient per year – or the cost of a cup of coffee a month.
We can protect what we’ve got with some relatively modest investment and reap the rewards with lower hospital costs, or we need to get ready for the Amazonification of healthcare, where we are treated as packages, not people.
I know what I’d prefer.
Do you have a story you’d like to share? Get in touch by emailing jess.austin@metro.co.uk.
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