Open letter to all our patients

Dear Patients,

General practice is in crisis, but we are still open and here for you…. let us explain.

During the pandemic general practices have been falsely accused of not pulling their weight and being ‘closed for business.’ As you know, our doors were never closed. We want to reassure you that we are here and we are consulting in many different ways i.e. telephone, face to face, video and online consultations. These changes in how we consult have been necessary to protect patients and staff from further spread of Covid-19.

There is also the narrative that GPs and clinicians are not seeing patients face to face. We never stopped seeing patients face to face throughout the pandemic. There was a period at the peak of the pandemic when all patients had a phone call before a face to face appointment or being asked to use alternative services based on their symptoms. We have many patients who are extremely grateful that they have the option of a remote phone call which means they do not have to take time off work and travel to us for something that can be resolved through a phone call.

Currently, all pre-bookable appointments at the surgery are telephone initially. Same day appointments are a mixture of telephone and face to face depending on clinical need and patient preference. However, if after a telephone call the clinician felt that the patient needed a face to face, then an appointment is booked for the same. All chronic disease review clinics are face to face. Earlier this year, we restarted our contraception (coils and implants) and minor surgery clinics too which are all face to face. E-consultations and video consultations via LIVI are also available.

Our appointment statistics for August 2021 are as below:

  • Face to face appointments: 1838
  • Telephone appointments: 1357
  • E-consults: 352
  • Home visits: 40

This is 20% more than the number of appointments provided in August 2019 before the pandemic.

90% of healthcare starts and finishes in general practice. Prior to the pandemic, we were already struggling due to decades of underinvestment.

We would like your support and understanding and we hope that this letter will offer insight into the challenges we are facing and the consequences this is having on our patients and staff.

Over the past year our workload has grown significantly. In March 2021 (see reference 1), general practices in England provided over 28.5 million appointments. This was 5 million more appointments than in February 2021 – the previous month – and 2.3 million more appointments than pre-pandemic times in March 2019 (see reference 2) .

In addition, the ongoing significant decrease in the number of GPs (see reference 3) and practices, with practices closing nationwide largely due to financial instability and inability to recruit new GPs to replace those retiring, is adding more pressure (see reference 4).

Whilst trying to cope with this increase in demand and reduction in resources, general practice has been the core of the highly successful Covid Vaccination Programme, delivering the majority of doses.

Finally, just like you, many of us have been affected by COVID. We have lost family and friends, had children isolating at home while we were trying to work, and felt overwhelmed and constantly exhausted by the demands of our work. Our commitment to serving our patients has, however, never changed.

The misrepresentation that we are ‘closed’ has resulted in more patients complaining about their practices and our colleagues and staff becoming demoralised.

When hospitals had to close whole departments, general practices were left to support those patients with complex chronic conditions. The huge backlog in hospitals, added to hospital departments restarting their outpatient clinics means the work they send to general practices is increasing daily. We are asked to arrange blood tests and scans, prescribe medication, arrange follow up and issue sick notes. This is in addition to our own workload. This further reduces general practices’ ability to help their patients.

In addition to all this, we are being asked to implement digital/online services for patients. These are great ideas and we fully support them but with the same number/reduced workforce and no funding for extra services it is unsustainable to match the high demand that comes with online access. It also presents a barrier to those patients who are less IT literate in gaining access to healthcare.

The ever-increasing workload, negative comments, and underinvestment is having a significant effect on our colleagues with 20% more GPs presenting to mental health services during the pandemic compared with the year before (see reference 5). The BMA report that over a third of GPs are considering early retirement in the next 12 months and 22% are planning to leave the NHS (see reference 6).

So what are we asking you, our patients, to do?

Be Reassured

We are here. We are working in different ways than before the pandemic and with a wider workforce of healthcare professionals. We will see you face to face, if needed, even if that might be after we have had our initial telephone consultation. If you have symptoms you are worried about please do contact us.

Be Respectful and Kind

Please respect that GPs and their staff are working harder than ever to provide healthcare. Being abusive and rude will not get you seen quicker or improve your outcome.

Be Self-Sufficient

If you or your child have a minor rash, signs of a cold, or other minor symptoms try home remedies, look for advice from www.nhs.uk, or ask for help from a pharmacist. Only seek an appointment if you have serious symptoms or are advised to do so by a pharmacist.

Be Prepared

Keep simple remedies including paracetamol or ibuprofen at home. Order your repeat medications well in advance. Think about signing up to the NHS App or other App provided through your practice.

Be Thoughtful

Practices are receiving a massive increase in complaints. Each complaint takes staff away from patient care to respond to. Before complaining, think whether it is appropriate. Is it due to an error or mistake which practices should know about to change or improve their services, or is it relating to the significant reduction in the current capacity to provide services by practices or hospitals and therefore no change is possible?

Be COVID Aware

If you develop COVID like symptoms, please do NOT attend the GP surgery in person. Please arrange a COVID test and if you are unwell and need to speak to a GP then have a telephone consultation initially. Be aware of current guidance.

Look at www.nhs.uk/conditions/coronavirus-covid-19.

Be Patient

All health services have been significantly affected by the pandemic. Your GP cannot change this. We cannot get an appointment or investigation brought forward unless there has been a significant change in your condition.

Be Cancer Aware

We are concerned that the number of patients presenting with symptoms of possible cancer or other significant illnesses has reduced during the pandemic. If you or someone you know have worrying symptoms, then please do not delay but make an appointment as soon as possible. See www.nhs.uk/conditions/cancer/symptoms.

Be Assured

We are still here for you when you are ill and need us. Late presentation of severe illness, including mental health, is harder to treat so do contact us if your condition is not resolving or you need to discuss worsening of a pre-existing health problem – general practice is open and here to help.

We send our sincere sympathies to everyone who has been directly and indirectly affected by the pandemic. We understand and feel the impact too.

We hope that this letter has helped to explain the pressures that general practice is under. Please continue to work with us to protect services and patient care.

Yours faithfully,

Birchwood Medical Practice

References

1. NHS Digital: Appointments in General Practice March 2021 www.digital.nhs.uk – Appointments in General Practice March 2021

2. The number of appointments in LLR was 597,181, compared with 543,404 in March 2019.

3. NHS Digital: General Practice Workforce 31 March 2021

4. Pulse Today: Almost 800 GP practices have shut over the past eight years www.pulsetoday.co.uk – Almost 800 GP practices have shut over the past eight years

5. Pulse Today: 22% more GPs presenting to burnout service than pre-Covid www.pulsetoday.co.uk – Gerada: 22% more GPs presenting to burnout service than pre-Covid

6. BMA: COVID-19: analysing the impact of coronavirus on doctors www.bma.org.uk – COVID-19: analysing the impact of coronavirus on doctors