Flu vaccine and blood test tube shortages – along with a ‘new’ access improvement programme* – look set to further stress a primary care network already hamstrung by workload and recruitment issues, abuse from patients, attacks by the media and mixed messaging from NHS England.

Meticulous preparations at GP surgeries across England for this winter’s flu vaccination programme have been thrown into disarray by a two-week delay, thanks to “unforeseen road freight challenges” at supplier Seqirus and a lack of contingency planning by central government.

These ‘challenges’ relate to a shortage of HGV drivers – caused by post-Brexit immigration rules and covid restrictions – and mirror the supply chain issues experienced in recent weeks by retailers like Tesco and fast-food outlets such as McDonald’s and Nando’s.

Meanwhile, with little warning, NHS England (NHSE) told GPs last month to cancel all non-essential blood tests until mid-September, owing to a production shortfall at blood test tube manufacturer Becton Dickinson.

Both problems are predicted to cause administrative nightmares for surgery staff, as well as extra work for already stretched GPs, and could increase the likelihood of abuse from patients.

On the question of testing, British Medical Association (BMA) council deputy chair Dr David Wrigley told online newsletter Pulse last month, “Many GP practices will now have to spend hours assessing which already scheduled tests can or cannot be cancelled and this takes time away from frontline patient care when it is most needed. Cancelling tests makes patients anxious and can mean a missed diagnosis.”

And Dr Richard Vautrey, BMA GP committee chairman, predicted that the delay to the flu vaccination programme will only add to practices’ already unsustainable workloads, and is likely to cause unnecessary anxiety for patients.

Workloads and recruitment

In fact those relentless workloads – driven by an ongoing recruitment crisis predating the pandemic, and exacerbated by a post-covid surge in demand – are now an everyday fact of life for most practices, and have inevitably led on occasion to patients having to wait for non-urgent appointments.

A survey of London GP practices in June this year, for example, revealed that more than half described the demand for appointments as unmanageable – and showed that half of them had vacancies too.

Across the UK the number of fully qualified, full-time equivalent GPs per patient has dropped by 10 per cent in the past five years, and vacancy rates nationally show one in seven posts are unfilled. There are also now fewer GPs per head of population in England than there are in comparable countries in Europe.

Even the NHS 111 helpline reported last week being short of 70,000 GP appointment slots because of continuing high levels of demand.

But despite that, GP appointments are now actually up 31 per cent compared with pre-pandemic levels, and more than 50 per cent of appointments have been delivered face-to-face throughout the pandemic, according to figures from NHS Digital.

Nevertheless, last week the Health Service Journal reported that GPs at one of the largest GP groups in England – Modality Partnership – were regularly breaching daily ‘safety levels’, with average number of daily patient contacts (face-to-face or phone consultations) up from just over 20 to nearly 50. The BMA puts the ‘safe’ number of contacts at 25-30.

That’s why the Royal College of General Practitioners (RCGP) in July called for a five-point emergency rescue package for general practice – entailing the recruitment of 6,000 more GPs (as already pledged by the Tories during the 2019 general election campaign) and 26,000 extra practice nurses and receptionists – and why last month the BMA followed suit by launching ‘Support Your Surgery’, a public campaign to rally support for GP surgeries and push for increased government investment.

Abusive patient behaviour

Verbal and physical abuse of surgery staff has taken off rapidly during the pandemic.

A survey taken last October by the Medical Protection Society (MPS) revealed that more than one in three doctors had been the victim of such abuse by patients or their relatives in the preceding six months after the first lockdown began, and that many instances stemmed from a mistaken belief that GP practices were closed. Similar research, undertaken by the MPS last month, showed that staff at three in four surgeries had experienced verbal abuse.

Comparable findings emerged from a BMA survey of 2,400 doctors, also conducted last month. According to the association’s research, more than a third of doctors had experienced verbal abuse and threats – as well as violent assault – with GPs the most likely to be targeted. Nearly 70 per cent of GPs interviewed said such abuse had worsened over the past 12 months.

And according to a report in the Independent, again last month, some surgeries have received bomb threats, others have been daubed with graffiti, while staff at one practice fell victim to anti-vaxx hate mail and were sent text messages describing them as ‘Nazi b******s’.

It’s no wonder then that more GPs referred themselves to the Practitioner Health programme, a service providing mental health support to doctors, in the past 12 months than in the previous nine years in total.

Right-wing media messaging

Much of the abuse suffered by GPs and surgery support staff stems from the false perception among many patients that practices are closed and appointments are unavailable. It’s a perception that’s been widely promoted by several right-wing media outlets – and subsequently amplified on social media sites like Mumsnet – since the pandemic began. And it is gaining momentum.

Two weeks ago one journalist at the Mail seemed to be outraged simply because GPs were able to earn the same from virtual appointments conducted from their homes as they could from face-to-face appointments in surgeries, backing up the accusation with a pointed reference to the average GP’s salary.

Two follow-up pieces have appeared in the Mail over the past few days: the first was a ‘special report’ claiming to ‘lay bare the grim truth’ and seeming to suggest GPs might be “obstinate and idle”; the second was a comment piece headlined, “A betrayal of the NHS: Janet Street-Porter says the only people GPs are keeping healthy with their scandalous refusal to meet patients face-to-face are themselves”.

Equally ‘on message’ were three pieces in the Telegraph appearing over the same weeks as the Mail stories, featuring such headlines as: “Are GPs who refuse face-to-face appointments breaking the law?”, “Time to turn the heat up on GPs who won’t see us face to face” and “Vets serve pets better than GPs do [the] public”.

Both titles seem to have forgotten that NHSE actually mandated a move to ‘total triage’ in March last year – a move dependent on remote rather than face-to-face consultations, and described at the time by former health secretary Matt Hancock as “remote by default”.

They may also not have noticed that last week NHSE actually instructed primary care providers across England to maintain covid infection protection and control procedures – despite them being relaxed across most other settings last month – in a move that is said to have led to thousands of appointments being cancelled through no fault of GPs.

Misrepresentation of GPs’ performance has gained traction since the pandemic began. An analysis by Pulse earlier this year, looking at negative media coverage of GPs in 2020, found that nearly half of the articles appearing suggested practices were either shut or providing poor access to appointments, and claimed GPs were ‘refusing’ to work or should be ‘back at work’.

Lack of support from NHSE

NHSE has adopted a fairly docile, almost ambivalent stance on media attacks aimed at GPs. Last September it seemed to echo the stance of the Mail and Telegraph, writing to all practices to ‘remind’ them that patients must be offered face-to-face appointments when they need them.

Four days later surgeries reported that practice staff were being abused by patients following publication of incorrect media stories about a lack of appointments, leading the BMA’s GP committee to demand NHSE issues a correction to counter the negative coverage.

Two months after that, in November, former RCGP chair Professor Dame Clare Gerada suggested NHSE shouldn’t leave it to GPs to correct misinformation, and should instead set up a rapid rebuttal unit. But in the same month, NHSE primary care medical director Dr Nikki Kanani merely pledged that the organisation “can and will do more” to explain to the public that GP practices are actually open.

In May this year, however, NHSE was again writing to GPs saying they must offer face-to-face appointments, and so the negative stories continued, prompting RCGP chair professor Martin Marshall to write to the Times to challenge the ongoing media criticism.

Only last week one GP told Pulse they felt there was “a deliberate and co-ordinated attack” by the right-wing press, with an underlying agenda patients were starting to believe if left unchallenged. In the same issue Pulse also quoted BMA GP committee chair Dr Richard Vautrey questioning NHSE’s position: “NHSE and the Government have a responsibility to the public to challenge this damaging and inaccurate narrative and restore confidence in GPs and all those who work with them.”

But the news that NHSE is not planning a public information campaign to explain why GPs are cancelling non-urgent blood tests is hardly reassuring, posing as it does a risk of further abuse from angry patients towards surgery staff.

And NHSE could certainly do more to limit the transfer of work from secondary to primary care – a major concern of doctors which was highlighted in a survey last month by GPonline. Earlier this year the same publication touched on how hospitals were dumping ‘endless tasks’ on an already overloaded GP network.

*Flagged up in a Telegraph ‘exclusive’ just as the latest issue of The Lowdown was being put together, this programme seeks to put pressure on almost 1000 GP practices – selected by NHSE – to offer more face-to-face appointments. According to the story, the ‘access improvement programme’ aims to assist these practices – many of which NHSE acknowledges simply have too few staff to provide a safe level of services – by offering them an unspecified amount of additional funding and a ‘dedicated adviser’ to enable them to see more patients in person. It’s unclear if this story relates to the forthcoming national GP access improvement programme, which has already been announced as an update to the GP contract agreement 2020/21-2023/24.

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