Wed 28 July 2021

Concerns about patient and staff wellbeing are being raised by campaigning groups, as GPs struggle to meet rising patient numbers and decreased staffing levels, reports Sian Norris

GPs across the UK are facing a “crisis” as a system that was just about coping before the Coronavirus pandemic is now on its knees, doctors have warned.

Dr Julia Patterson, CEO of EveryDoctor UK, told Byline Times that the difficulties facing GPs “is the next stage of our national health emergency” as the knock-on effects of the COVID-19 crisis “have caused primary care to be severely affected”. She said that more needs to be done “to keep patients safe in the community” and support NHS staff.

According to data published last month by the British Medical Association (BMA), there are now 0.46 fully qualified GPs per 1,000 patients in England. The number of patients per practice is 22% higher than in 2015, but the workforce has not grown to meet this demand. GP appointments are also at their highest levels since 2018. Compared to March 2020, the number of appointments have increased by 18% to 4,352,612.

Data from 2019 found that, in England, the average number of patients per GP was 2,087 – an increase of 56 on the previous year. In some areas, that number was 2,900 patients per GP. The number of full-time, fully-qualified GPs fell by 441 between 2018-19. 

A survey published earlier this year by the BMA heard from 4,320 respondents, almost half of whom said that they were currently suffering from depression, anxiety, stress, burnout, emotional distress or another mental health condition. Of those, 40% said their suffering was “worse than before the start of the pandemic”.

Dr Alex Perry (not their real name) works as a partner in a GP surgery with a patient population of 27,000. He believes that the pressures caused by the GP-to-patient ratio is something which “the public don’t understand” and that “there is a swathe of people who can’t cope anymore”.

The results of the BMA’s 2021 survey tally with the experiences shared by GPs with EveryDoctor UK. One GP told Dr Patterson that his stress and anxiety was now so severe that he had started to hope he would get a severe illness as he could see no other way to step away from work without feeling as though he would be letting his patients and colleagues down.

“We are very concerned about patient safety,” Dr Patterson told Byline Times. “And we are very concerned about our staff.”

The Pandemic’s Perfect Storm 

As the statistics show, GPs were struggling with a high patient-to-doctor ratio before the Coronavirus hit. In response to these pressures, a policy was introduced to bring allied healthcare workers such as nurses and physiotherapists into surgeries to share the workload – although GPs were still required to manage the staff members and oversee patient care. 

“The Government is on this trajectory of getting anybody that isn’t a doctor to cover medical services,” Dr Perry told Byline Times. “But then a lot of the work comes back to us.”

Since the pandemic, the pressures have increased. In many cases, allied healthcare professionals were redeployed and moved to the frontline of the Coronavirus crisis. At the same time, GPs had to change their way of working and conduct telephone appointments, with face-to-face appointments only provided for urgent cases. 

“Even in those cases, patients didn’t want to come,” said Dr Perry. “There was no national model about what to do when the pandemic hit. We set up a project to call all 3,500 of our patients aged over 75 to check how they were coping. Throughout the pandemic we never stopped seeing people who needed seeing.”

The need to treat rising numbers of COVID-19 patients in hospitals safely led to secondary care such as surgery or cancer treatment being cancelled or delayed. GPs then had to support the clinical needs of patients who, in normal circumstances, would have been seen by a specialist. 

“If a patient needs an operation and has been referred to a surgeon, their GP would still be providing care for that patient,” said Dr Patterson. “But the extensive waiting times for operations due to pressures of the pandemic mean that GPs are managing patients with less specialist input. This is incredibly stressful for both patients and GPs.”

As a result, “they have been holding a higher burden of clinical need than they would normally have to,” she said. “That’s concerning because GPs worry about their patients and want to have a specialist involved as early as they possibly can.”

This has been the experience of Dr Perry, who said that the change towards GPs having a higher clinical burden pre-dates the pandemic. “Patients who would have once been looked after by a specialist in hospital are now shifted back to us,” he explained.

The pressure was exacerbated in December when GPs were tasked with implementing the highly successful vaccine roll-out. 

“These GPs would have been seeing patients on top of having to set up vaccination centres,” said Dr Patterson. “Then another wave of Coronavirus hit so GPs are now managing this enormous burden involving patients who should be accessing secondary care and can’t. Something has shifted recently that has made this start to feel completely unmanageable.”

‘We Are People Too’ 

The 2021 BMA survey found that 30% of respondents have taken on additional unpaid hours to try and meet the growing workload. One GP who contacted EveryDoctor UK had spent 24 hours in their surgery to process patients and admin. “We are hearing from GPs having to work 15 hour days as standard,” Dr Patterson said.

The increased workload is a symptom of the perfect storm of increased patient numbers and reduced staffing levels, with 40% of the survey’s respondents telling the BMA that non-COVID0-19 patient demand is “considerably higher” than before the pandemic. 

GPs are understandably concerned that long hours and stress will impact on patient safety.  

“I have been working from 5 am to midnight,” Dr Perry told Byline Times. “And I have enough insight to know that I am safe when I am at work. But mistakes can be made when you are that tired.”

He believes that part of the issue is that GPs are simply not valued – including by the Government and some sections of the media. This has increased the pressure put on them, as patients become impatient and even abusive with surgery staff.

“We are people too,” Dr Perry said. “We’ve got children, we’ve got partners, we were scared of getting Coronavirus – both myself and my partner were severely ill with the virus. We have our own fears, our own families, our own situations. It’s not fair to act as if we are not human beings.”


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