GPs complain of 'malicious criticism' over plan to increase face-to-face appointments

·12 min read
GP anger over 'unsafe' plans to reduce social distancing and increase face-to-face appointments - PA/Anthony Devlin
GP anger over 'unsafe' plans to reduce social distancing and increase face-to-face appointments - PA/Anthony Devlin

GPs have complained about the "malicious criticism" doctors are facing after finding themselves at the centre of a "public storm" over plans to increase face-to-face appointments.

The NHS is ploughing millions of pounds into a new package of measures aimed at improving access to GPs, but practices which fail to provide an "appropriate" level of in-person appointments will not be eligible for the new funding.

The measures, spearheaded by Sajid Javid, the Health Secretary, also include a review of social distancing at GP surgeries – rules said to be hampering patients' ability to see a doctor in person.

England's Chief Medical Officer Chris Whitty said that the swing away from in-person appointments had gone too far.

But doctors have criticised the Government for being "out of touch", and claim the description that doctors are underperforming is "insulting".

Professor Martin Marshall, head of the Royal College of GPs (RCGP), told delegates that GPs had worked tirelessly to support patients through the pandemic, and are now helping all those with conditions such as long Covid as well as patients on long NHS waiting lists.

He said GPs have found themselves at the centre of a "public storm over face-to-face appointments".

He added: "The malicious criticism of the profession by certain sections of the media and by some politicians as a result of the shift towards remote working - introduced to keep our patients and our team safe and keep the service operating - has been the worst that I can remember in over 30 years as a GP.

"This widespread vilification of hard working GPs and our teams is unfair, it's demoralising and it's indefensible.

"No-one working in general practice deserves this abuse."

The number of face-to-face GP appointments has fallen dramatically since the start of the pandemic and has failed to recover. The latest monthly data showed that only 58 per cent of appointments took place in surgeries – down from 80 per cent of all consultations before the Covid crisis.

The true number is likely to be lower, with The Telegraph revealing this week that some telephone consultations are being counted as face-to-face meetings. Campaigners and patients' groups have warned that many vulnerable people have been unable to access care, with coroners linking a series of deaths to remote appointments.

Whitty: Face-to-face not where it needs to be

Face-to-face access to GPs is "not where it needs to be", Professor Chris Whitty has said.

Speaking at the RCGP annual conference he said in August 2019 the profession was not carrying out enough remote consultations but the Covid pandemic caused a "painful gear change" in the opposite direction.

But that is "not a sustainable position".

"Now the pendulum is already swinging back and it will need to come back to a point that isn't quite out where it was in the middle of Covid, nor is it where it was in August 2019, I don't think it's settled at the right point yet," he said.

He said the profession has got to "have a debate with the public who we serve" and work out the right balance.

"I think what we need to do is we need to accept that we haven't reached the optimal point yet," he said. "But I think what we should do is not allow this to be driven by a public discourse, it's quite reasonable the politicians make comments I'm not criticising that at all. But the actually the correct dialogue, to get us to the right place on this is between us the profession and more accurately, you the general practice part of the profession, and patients".

Health Secretary Sajid Javid has defended the Government's decision to publish league tables for family doctors.

Mr Javid said that providing "more data, more transparency" would help drive up standards at GP practices across the country.

"It is important that patients have this information because I want to see a levelling up of healthcare throughout the country. We do need to understand what the differences are in healthcare provision across throughout the country," he told Sky News.

He said the Government was providing an additional £250 million in support for GP practices.

"This whole package today is about support. This is all about helping GPs so that they can do what they do best, which is seeing their patients," he said.

The bluebrint for improving GP services

The blueprint for improving access, published by NHS England working closely with the Department of Health and Social Care, includes a number of measures including:

  1. The new investment will fund locum doctors as well as support for GPs from other health professionals such as physiotherapists and podiatrists.

  2. The NHS said GP practices must "respect preferences for face-to-face care unless there are good clinical reasons to the contrary".

  3. Local health systems will be given some freedom to determine how to tackle access problems, which could include "walk-in consultations".

  4. But the NHS will "increase its oversight" of practices with the most acute issues in relation to access, it said.

  5. GP appointment data will be published at practice level by spring - so people will be able to see how well their surgery performs compared to others. The NHS said this will "enhance transparency and accountability".

  6. Practices which do not provide "appropriate levels" of face-to-face care will not be able to access the additional funding and will instead be offered support. Though it is not clear what the level of appointments need to be face-to-face.

  7. The money will help upgrade GP surgery telephone systems - which will hopefully drive down long waits on the phone.

  8. The Government will reform who can provide medical evidence and certificates such as fit notes and DVLA checks - freeing up more time for appointments.

  9. - Infection control will be assessed which could lead to social distancing in practices being changed or downgraded.

  10. Patients will also be able to see different types of clinicians in general practice including nurses, pharmacists and paramedics.

Backlash as doctors hit back at plans

Doctor Ellie Cannon claimed that patients were not seeking face-to-face appointments, and in a tweet directed at the Health Secretary Sajid Javid said: "There are not enough doctors to do this. Most people I speak to do not want to see a GP when a timely phone call is enough."

Another doctor, Rachel Warrington, who runs a GP surgery in Bristol said there was no way of reducing social distancing safely and that the "preoccupation with face-to-face appointments is inappropriate".

She added: "We are seeing patients face-to-face, the only difference is that we know who's coming in the building. We stagger patients so they're not overlapping in the waiting room and I think it's a much safer way to practice medicine instead of what the Health Secretary is proposing we go back to."

Her comments were echoed by Dr Jess Harvey, a Shropshire GP, who told the BBC's Radio 4 Today Programme: "The more I read and hear about this proposal the less I think the Government understands general practice, how its run and to be honest and the less in touch they are with what is going on in the real world in the NHS and what we're facing.

"GP staff are currently sacrificing their own health and well-being to maintain a service in what has been a chronically underfunded and under-resourced area for years.

She added: "I think the public needs to understand the staffing pressures that we're under.

"The abuse that my reception staff have got has escalated beyond my imaginations since Covid and we are facing resignations at the moment from my practice because of this.

"Had there been some sort of defence for us from the Government then that might have helped.

"General practice is on its knees. I don't know anybody in general practice at the moment who isn't working their knuckles to the bone and frankly for Mr Javid to describe us as underperforming is insulting. I would invite him to see what I'm doing and tell me where I'm underperforming.

"Where is the evidence? we're seeing more people than ever. We are seeing more appointemnts than pre-pandemic.

"We have provided over 70 per cent of the vaccination programme that the Government hail as their great success, and that's general practice doing that, and that was in addition to our normal work."

The plans announced by the Health Secretary has prompted a fiery response from health professionals, including the British Medical Association.

Professor Martin Marshall, Chair of the Royal College of GPs, said he was concerned about the increased scrutiny, and added: "We knew we were unlikely to get a silver bullet to solve all the challenges GPs and our teams are facing, but we hoped to see more tangible solutions to improve the care that can be delivered to patients. Our hardworking members will see this package as a missed opportunity that will do little to improve the intense pressures that are preventing them from giving their patients the care they need and deserve

"The RCGP has always been very clear that a blend of remote and face to face consultations are necessary, and that post-pandemic this should be a shared decision between GP and patient. We know some patients prefer to see their GP face to face – but good care can and is being delivered remotely and some patients prefer it."

Dr Harvey said recruiting locum staff would cause GPs to leave the health service.

She said: "They talk about recruiting extra locums, I've heard the Tory Government talk about a magic money tree - there isn't a magic locum tree. My practice tried to recruit a maternity locum for a year and didn't manage it, and we're a lovely practice to work for.

"There aren't locums out there that are clamouring to work because there's been such a toxic environment created by the Governments of past times now in general practice.

"There is no capacity in the system. If we go to the locum system, the already demoralised GPs thinking of leaving will leave. Then you're in a disaster zone. You're going to have an expensive locum market force economically and medically, that's just poor practice."

Dr Amir Khan, speaking on Good Morning Britain about face-to-face appointments, said that the issue was capacity.

And Dr David Wrigley, deputy chairman of the BMA, said on Twitter: "'Funding for locum GPs', says ⁦Sajid Javid. ⁩There are no spare GPs because working in general practice is so toxic and impossible due to your rhetoric and lack of support. This is all on your watch."

He added: "This Government is completely out of touch and is now telling GPs how to do their job.

"I have never seen colleagues at such a low ebb and at rock bottom.

"NHS general practice was once the jewel in the crown of our NHS. It is being destroyed by this Government."

No-show Javid called 'cowardly' by GPs

The Health Secretary, Sajid Javid, was due to speak at the Royal College of GPs annual conference in Liverpool on Thursday, but has pulled out at the last minute causing anger among doctors.

Instead, he was pictured arriving at a doctor's surgery in south-east London to speak to GPs following the publication of the Government's blueprint for improving access to GP appointments for patients.

Mr Javid was greeted by Dr Jaideep Israel, principal GP of The Vale Medical Centre in Forest Hill, before he headed into the practice.

Sajid Javid at a doctor's surgery - Leon Neal/Getty
Sajid Javid at a doctor's surgery - Leon Neal/Getty

Opening the conference Dr Steve Mowle, RCGP Honorary Treasurer, said they were told Mr Javid could no longer attend because "he had to clear his diary to ensure he can fight for the NHS in the spending review" which was met with laughter from the delegates.

Doctors have reacted angrily on Twitter accusing the Health Secretary of failing to turn up and defend his new GP winter plan.

"Disgraceful [Sajid Javid] has cancelled his attendance at [the RCGP conference] this morning. On the day his ‘support’ package is announced - to not attend and engage with the profession is shocking - and highlights how out of touch the government is with the crisis in General Practice," wrote Euan Strachan-Orr, a GP registrar in Liverpool.

Others called the move "utterly disgraceful and cowardly".

Jonathan Asthworth, Shadow Health Secretary, said: "What?! The Health Secretary just cancelled at the last minute talking to GPs about his big promise to guarantee appointments?"

It is understood Mr Javid is visiting a GP surgery in London this morning and timings did not work to attend the conference.

Dr Michael Mulholland, vice chairman for professional development at the Royal College of GPs, told the college's annual conference in Liverpool there had been a change to the line-up for the meeting.

To laughter from the audience, he said: "Unfortunately we do have one change to the programme. The Secretary of State for Health for England is unable to join us today either in person or by video link.

"This is because, and I need to get this right, he had to 'clear his diary to ensure he can fight for the NHS in the spending review, or be anywhere else you may have seen or heard him this morning'.

"As I said before, we didn't start the fire."

Health Secretary Sajid Javid was interviewed on morning news programmes earlier on Thursday, where he said he is "sorry" for the losses and suffering which have occurred during the Covid-19 pandemic.