When a lot of things go wrong at the same time the result is often a high stakes blame game involving three players: the general public, the mass media and the government. If any two concur on a suitable target the third will not be long in coming on-side. After over eleven years in power, a Tory government might be expected to get some blame for a National Health Service starved of adequate funding and staffing. A cherished national institution staggering under the weight of rhetoric, re-organisation, high expectations and prolonged pressures, serving an overweight, aging and unhealthy population without an integrated health and social care system for the frail and vulnerable, but with a door marked ‘private’ available for those with the money so they won’t need to wait their turn, has for the last two years been overwhelmed by the needs of COVID sufferers and the responsibility for curbing the spread of the virus. We do not hear a mea culpa from government nor are we likely to.
But someone must be to blame. Enter, telephone in one hand, stethoscope in the other, your local GP.
When it comes to government incompetence there is always recourse to deflecting attention elsewhere, ideally to some group deemed blameworthy. In Britain this tactic leans heavily on the dark arts of the right-wing press. The Daily Mail detects pockets of popular anger and resentment like a well-trained police sniffer dog. The paper’s campaign to reverse the decrease in face-to-face appointments with ‘the family doctor’ is a study in misrepresentation. We learned from the Mail on-line of 16 September that it may have led to “an 88% spike in stillbirths during the pandemic” - despite the article showing no connection whatsoever between GP appointments and stillbirths. There is no connection. An editorial error apparently occurred. Understandable as the Mail was having to compete with the The Telegraph’s headline “Vets serve pets better than GPs do the Public” of 26 August.
The Mail followed up by intimating that GPs had fewer consultations on Fridays because they were taking long weekends off. I looked at the analysis of phone calls for a week in May this year before the COVID infection rate began climbing and when vaccinations were in full swing to a northern England practice with – below average - 5,500 patients. There were over 1,350 incoming calls on the Monday but only 451 on the Friday. Could there be some correlation between lower demand at the end of the week and the lower level of consultations on Fridays compared with other days?
But what of the main beneficiary of the press campaign against GPs, the government? Our new Minister of Health, Sajid Javid, entered the blame-game on 14 September. “It is high time”, he said, “GPs started operating in the way they did before the pandemic and offering face-to-face appointments to anyone who wants one”. Well, he was relatively new in the job. He knew there weren’t overall enough GPs but he might have wondered if extending the average GP working day – which would be needed if GPs were to comply- from ten hours to 24 hours was a feasible idea.
And what of the general public and their perceptions? The work that GPs do when they are not face to face with patients is rarely taken into account by people anxious to see a doctor. For example, apart from phone consultations, there is routine management of the practice, keeping patient data up-to-date, checking test results, liaising with clinicians in hospitals, acting as a substitute for unavailable clinicians, visits to care homes, and so on. And then there is the additional demand, 3.2 million more patients since 2015, and at a time of falling GP numbers. Because COVID dissuaded patients from checking on medical symptoms, many more are now contacting their GP with serious conditions requiring immediate attention – doctors describe themselves as ‘holding more risk’. And the risks are rising.
By dog-whistle and more blatant means, the government and right-wing press have been encouraging the public, who have no way of observing the daily work-load of a GP, to think that they (who pay for the NHS through their taxes) are being short-changed by fat-cat doctors. As long ago as 2017 the Mail was working on creating resentment at GPs’ income asserting that they were earning £200,000 per annum. In reality such earnings were achieved by only 270 out of the country’s 28,000 fully-qualified and full-time equivalent GPs, those who managed a group of practices counting many thousands of patients. The average GP’s income is about £98,000 comparable to that of other professionals in senior and responsible positions who expect to work at least a 10 hour day.
Doctors aren’t saints. They do seek to maximise their incomes. A GP practice is an unusual form of business, with partners and salaried employees providing services to the public and relying most often exclusively on public funds. Increasing the number of employees deployed to answer phones or interact face-to-face with the public would increase the practice’s costs. Hanging on the line for ages irritates healthy people let alone someone feeling ill and anxious. But things have gone beyond understandable irritation to verbal abuse of practice staff and in one mid-September incident in Manchester a serious physical attack on four staff members leaving two hospitalised with head injuries.
Undermining this country’s front-line of health care, its 28,000 GPs – yes there are not enough - might sound a smart political tactic but is utterly irresponsible. GPs are the gateway to hospitals and further treatment. They ensure that unnecessary demand for specialist treatment, tests and medication is controlled. For this system to work it is essential to maintain the bond of trust between doctor and patient at its heart. That trust is now under threat at a time when it is most needed. Trust is easy to destroy and so difficult to re-establish.
Of course General Practice can always be improved. Government should encourage innovative ways to meet the extraordinary demands now being made on it. But it is time to stop targeting GPs in the blame-game before it is too late and the sour conflict generated by a divisive political culture infects and grievously damages one of our national treasures.
See TheArticle 01/10/2021