Primary care needs urgent support so our sickest patients do not suffer…

My 82-year-old mother called her GP surgery early one morning this week; she was told there were no appointments, and to try again the next day. This is a concerning situation. It may be the practice is short staffed with staff off sick or in isolation, or they may have vacancies they cannot fill. The situation is getting worse and I fear will continue unless we face up to some changes.

General practice is getting worn down. The last Cabinet Secretary for Health called general practice ‘the foundation of the NHS’, and we know what happens when foundations fail. It was accepted that in Scotland we were short of hundreds of GPs before the pandemic and now we’ve been dealing with the pandemic since March last year and, despite scurrilous suggestions that we’ve been closed, we have been operational within the rules of infection control.

There’s a problem that we do not have accurate data on attendances at general practice, so while A&E can produce excellent data showing hourly variation in demand, general practice silently absorbs activity until it is saturated. This is something we must urgently attend to: the profession and the Government need this data, otherwise we are all blind to the crisis we are heading into.

What activity data we do have suggests that demand is now above pre-pandemic levels and for a host of reasons: patients held back problems during lockdown that they now present with, there is a backlog of long-term condition management, waiting lists for hospital elective care have considerably lengthened so patients often come back to their GP, there is a significant rise in mental health problems (and particularly low-level anxiety/depression that never reaches hospital).

We have the ongoing management of third-wave Covid cases and while the success of the vaccination programme has meant that hospital admissions are down, the pandemic continues to affect younger people and this tends to land on primary care. On top of all that we have the emergence of a new condition in long-Covid for which, in most areas, there is no comprehensive service available other than what the GP can provide. If that were not enough, we have the government’s Redesign of Urgent Care agenda, which seeks to redirect some A&E activity elsewhere, and of course where better than the GP? And finally, there’s the winter influenza vaccine programme and the plan for a Covid booster this autumn.

We cannot do it all, something will have to give, and it should not be our sickest patients. We need to retain our workforce and yet I know of many GPs who stayed on for the pandemic but who will shortly leave. And GPs get unwell too, many have suffered from the mental health strains of the last year, some have caught Covid and a few unlucky ones are suffering from long-Covid. We need to make best use of the GP time capacity we have.

The mass vaccination programmes are an obvious service that should be provided elsewhere (accepting very remote practices will likely continue to provide this service). Put bluntly we should not have GPs busy vaccinating well patients when their unwell patients cannot get an appointment to see them.

There needs to be better engagement with the public about what they should expect from the NHS; this is something we’ve been calling on since last September, we need better messaging to help the public understand the need for on-going triage to prioritise those patients who have greatest clinical need and to help the public appreciate the need for a realistic medicine approach to the appropriate use of the NHS.

Dr Andrew Buist, chair of the BMA’s Scottish GP Committee

Picture credit: Gordon Terris, Herald and Times Group

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