A leading Yorkshire GP has warned that the "tsunami" of people demanding appointments as we emerge from lockdown could leave vulnerable patients without the care they need.

Dr Brian McGregor is appealing for everyone to play their part in relieving the pressure on an overstretched system – and he has made it clear that there is no room for the abuse many hard-pressed practice staff are suffering from members of the public as demand for GP appointments outstrips supply.

A working GP in a village practice with 4,000 patients, Dr McGregor is Medical Secretary of YOR Local Medical Committee Ltd (YORLMC) – the professional voice for all NHS GPs and practice teams across the City of York and North Yorkshire. 

He responded to recent criticism over the availability of GP appointments, explaining: "Every GP has been working and doing their utmost during the last 15 months to make sure that we give patients what they need. We've actually been providing more appointments, particularly since October – nationally, a million more appointments every month, and from December we've also been providing the vaccination programme."

Dr McGregor said 60 million-plus doses of COVID-19 vaccine have been delivered nationally – 95 per cent by general practice staff. "That's on top of everything we do on a day-to-day basis, mainly run by volunteers from the clinical side, mainly run by people doing it in their own half-days off or in their own evenings off, or their own weekends."

He said that while the NHS "total triage" system is not GPs' preferred way of working, it was helping to reduce the risk to patients and staff of catching COVID-19. "Currently in the media, the biggest gripe and complaint about general practice is about the lack of face-to-face appointments and about the ability to actually contact practices. The simple fact is that demand is higher than capacity at the moment.

"At no point during the pandemic has general practice been closed. It's always been open, it's always been accessible and it's always been able to facilitate patient needs – although that may not be the same as a patient want.

"It's not about somebody being awkward, it's not about somebody blocking you, it's not about not giving you what you want – it's about assessing what you need and trying to make sure we address that need as quickly as we can.

"There's a process that we are following to keep people safe and to keep practices safe. Within that process, we need to hear what the problem is so we can decide where best to get you seen – sometimes, that won't be a GP. General practice now has a whole team of individuals, whether it be advanced nurse practitioners, our own nurses, healthcare practitioners, physiotherapists, pharmacists, paramedics – there's a whole group of individuals that are now providing care, and it may well be that you'll get better care than seeing a GP first and being redirected, and you might see people quicker than you would have done otherwise."

Safety

Dr McGregor said GP practices having to operate under restrictive social-distancing and infection prevention control measures – including cleaning between appointments and limiting the number of people in surgeries – meant a face-to-face meeting takes twice as long as it did pre-pandemic, and two or three times longer than a phone or online appointment.

He stressed that meeting all the current demand for in-person consultations would further reduce the number of available appointments, and that face-to-face consultations with a doctor do not always provide better care or the most appropriate solution for every patient. In addition, there are simply not enough GPs to go around.

"General practice was in trouble before the pandemic. Six years, ago (then-Health Secretary) Jeremy Hunt said we needed 5,000 more GPs. Up to 2020, when we should have had those 5,000 more GPs, we've actually lost another 1,000 GPs. The job was so stressful, so challenging, so difficult that it couldn't retain GPs and it couldn't encourage doctors to take it on as a profession.

"As the pandemic came about, some GPs returned from retirement, and almost every other GP upped their game and started increasing the hours they were working. Lots of the GPs that were nominally part-time – three days a week, but 12-14 hours a day – are actually working most other people's full-time, doing that 36 hours a week. The full-time GPs are genuinely doing 60-70 hours a week in their practices, slogging away to meet the demand that's coming through."

Dr McGregor also emphasised that coronavirus has not "disappeared", and that the Delta variant is much more transmissible than the original virus. He said that it can cause illness in one in 10 people who have been vaccinated, and is more likely to require hospital treatment. He underlined the importance of getting a PCR swab test from a testing centre if you have symptoms, as opposed to a lateral flow test which is for those without symptoms.

Appropriate care

Dr McGregor explained how we can all help relieve the pressure on the system. "When we talk about access to GPs, we need to talk about capacity. When you think about a health problem, think about where you're going to be most appropriately dealt with. Could you go online, could you look online for symptom checkers? NHS.uk will tell you an awful lot about most problems.

"Can you have a word with your pharmacist about what's going on? Is there anybody else you can talk to who might be able to give you some help and support about simple problems? Can you call 111, talk about the problems you're having and get some clinical advice? Can you use the online consultation tools that your practices have on their websites?

"And if all of those are not appropriate for you, you can call your practice and ask for a telephone consultation or maybe a video consultation. Then, if the clinician feels it's appropriate, you could be invited in for a face-to-face. But all of these other options are things that will reduce the number of phone calls coming into practices and make it easier and safer for those who have no other option or cannot use those other options."

He highlighted the "incredible number" of people call GP practices with vomiting and diarrhoea – which can usually be treated with simple self-care methods and over-the-counter remedies.

"Rather than thinking 'I should ring somebody and get them to tell me what to do', you should be thinking 'have I tried all the self-care methods I can try?' before you seek that expert advice and take up that time that could be used for people who are suffering from chronic problems, with more complex issues, and things that are not so minor.

"That's not belittling anyone's illness, because for you that bout of diarrhoea or vomiting is very significant at that time. But really, what you should be considering is, 'is this likely to be short-lived?' and 'could I deal with it myself without having to get advice?'"

Dr McGregor acknowledged that children are a "special case" – and an example of those whose health issues need to be prioritised by primary care staff.

"As GPs we understand that there are vulnerable members of our society that we need to take care of and we need to support.

"What we need from everyone is to allow us the ability to do so. The biggest and most significant worry for many people in the healthcare profession is that with this increased demand we have, it is almost impossible to allow us to give that greater care to people lost in that huge sea of demand – that tsunami of everyone trying to get access to general practice – and we do not want the situation where vulnerable individuals will deteriorate while we're dealing with things that could have been dealt with in other ways.

"One of our concerns is that the number of patients presenting to us with symptoms of cancer has gone down in the last year. What we don't know about, we can't deal with."

Dr McGregor highlighted symptoms such as unexplained weight loss, blood in your pee or poo, and unexplained lump and severe fatigue without a good reason as reasons to contact your local practice straight away. "If you're concerned, you need to be in touch with us, and we would want to deal with that on an ongoing basis. We want to investigate it, and we want to find out whether or not there is a case it could be something sinister.

"We would never discourage those individuals, and have never discouraged those individuals throughout the whole of lockdown and COVID, to come forward and allow us to provide care for them."

Abuse

While acknowledging the anxiety and fear prompted by the COVID-19 pandemic, Dr McGregor said there were no excuses for the abuse many practice staff have been experiencing from some members of the public.

"Our reception staff, our care navigators – they're all trained, and they're doing what they've been asked to do by the GPs – so that's why they need to know what the problem is and why they cannot just automatically put people into face-to-face appointments.

"Most of our reception staff are on little more than the Living Wage. They are human, they have families of their own – they are patients themselves. It is not reasonable to be shouted at, to be sworn at, to be denigrated and to be insulted.

"It's vitally important that we realise that in all of our relationships, in all of our interactions, we should be kind, we should be considerate. We should consider the feelings and thoughts of the person at the other end of the phone.

"We're not there to be insulted. We are not there to be shouted at and we're not there to be abused."

Dr McGregor said being kind despite facing frustration or disappointment was an example of how we can all help each other through the effects of lockdown.

"We fully appreciate that mental health deteriorated for almost everybody during COVID. When you're at home, if you're alone – and there's a lot of loneliness that came on during COVID because people couldn't go and look after each other in the way they had done previously – it is only going to have a detrimental impact on your mental health.

"We've seen the anxiety rise, particularly in some of the younger generation as they've not had the ability to have that same peer support and interaction that they would have had in years gone by. So we know, from our own staff and the impact that it's had on them, and our own families, and we also know from the patients we look after, that that stress, anxiety, pressure and that deterioration in mental health is a huge impact for everybody.

"What we need to do now is try to act as a society to make sure we're supporting each other as much as we can."

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