Open letter to patients in Leicester, Leicestershire and Rutland
Dear patients,
General practice is in crisis. Although often an overused word, this is currently an accurate description.
We write to raise very important issues and to ask you to work with us, your general practices, to help you and all your family, friends, neighbours and work colleagues to be able to appropriately access healthcare.
General practice remains the bedrock of the NHS as an effective, cost efficient health service. Ninety per cent of healthcare starts and finishes in general practice.
Prior to the pandemic general practice had significantly declined due to decades of underinvestment by consecutive governments. This meant that when the pandemic started there was less resilience than there should have been.
During the pandemic general practices rapidly changed how we delivered services to keep patients, their family and carers, and our staff safe, whilst continuing to provide a service without ever pausing.
During the past year practices have seen a significant increase in workload. Recent figures show that in March 2021[1] general practices in England provided over 28.5million appointments. This was 5 million more appointments than in February 2021, and 2.3 million more appointments than pre-pandemic times in March 2019. In Leicester, Leicestershire and Rutland the number of GP appointments since before the pandemic had increased by 54 thousand (10%) appointments per month[2].
This is at a time when there has been an ongoing significant decrease in the number of GPs and practices. The number of GP partners in England has fallen by 22 %[3].
The number of practices also continues to fall. 98 practices closed last year, meaning 263 thousand patients had to find a new practice. In the past 8 years 778 (10%) practices have closed, with 2.5million patients having to find a new practice.[4] This has been mainly due to financial instability and inability to recruit new GPs to replace those retiring.
On top of 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.
During the pandemic general practices have been falsely accused of not pulling their weight, and being ‘closed for business.’ As you can see the truth is far from this. But constant negative comments have resulted in more patients complaining about their practices and our colleagues and staff being demoralised.
When hospitals had to close whole departments, general practices were left to support those patients with complex chronic conditions. The huge backlog means that general practice will remain busy for the foreseeable future. As hospital departments restart their outpatient clinics these are often done remotely, and they frequently expect general practice to pick up their work (for example arranging blood tests and scans, prescribing medication, arranging follow up, issuing sick notes) in addition to our own workload. This further reduces general practices’ ability to help our patients.
The government is forcing through changes to general practice which we do not believe is in the interest of our practices or the majority of patients. One of these is the requirement for practices to implement digital/online services. This makes it much easier for younger IT savvy people to place ever increasing demands for advice and help about minor, self-limiting, conditions often as soon as they have started. This means that practices will have less and less time to provide services to those patients who do not have access to, or cannot use, IT but are more likely to be suffering from significant illness. The outcome will be an increase in health inequalities.
The ever-increasing workload, false 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.[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[6].
So what are we asking you, our patients, to do?
Be respectful and kind. Please respect that general practitioners and our 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, do not think GP first. 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 advised to 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 a new cough, high temperature or loss of taste or smell, it could be Covid. Do not contact your GP unless you have done a Covid test first. Do not attend at the surgery, as this could cause an outbreak, infect vulnerable patients or staff, and lead to the practice having to close all their services for a deep clean.
Be patient. All health services have been significantly affected by the pandemic with huge backlogs. Your GP cannot change this. Do not expect your GP to get an appointment or investigation brought forward unless there has been a significant change in your condition. You can only be moved up the list by making another patient wait longer.
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 https://www.nhs.uk/conditions/cancer/symptoms/
We send our sincere sympathies to everyone who has been affected by the pandemic. GPs and our staff have also been affected. Too many of our colleagues, family members, friends and patients who we have known for many years, have died or otherwise suffered.
We hope that this letter has helped to explain the pressures that general practice is under, why we cannot provide the level of service that you would like to receive and practices would like to provide. Please consider how you can help to protect services and ensure they are targeted towards patients with the greatest need.
Yours faithfully
General Practitioners and Staff in Leicester, Leicestershire and Rutland
[1] https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice/march-2021
[2] The number of appointments in LLR was 597,181, compared with 543,404 in March 2019.
[3] https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/31-march-2021 Fall of GP Partners from 21,688 in 2015 to 17,003 in 2021
[4] https://www.pulsetoday.co.uk/almost-800-gp-practices-have-shut-over-the-past-eight-years/
[5] https://www.pulsetoday.co.uk/news/workload/gerada-22-more-gps-presenting-to-burnout-service-than-pre-covid
[6] https://www.bma.org.uk/advice-and-support/covid-19/what-the-bma-is-doing/covid-19-bma-actions-and-policy/covid-19-analysing-the-impact-of-coronavirus-on-doctors)
