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8 July 2022
Dear Dr XXXXXXX
I am writing to you in the form of constructive feedback, not criticism. I am only too aware of the harsh constraints under which GPs and their colleagues in primary care are currently working and of the wider causes of this, of which more below.
I had a bout of COVID-19 at the beginning of 2022, which was much like a bout of flu. Several weeks later I experienced severe pains in my joints and muscles. I waited a couple of weeks to see what happened before going online to request a face-to-face consultation with a GP. I mooted the possibility in my request that I was suffering from polymyalgia rheumatica. A face-to-face consultation with a GP was declined in favour of a phone call. I gathered this was the default option at the practice. A GP I’d never met decided I likely had long COVID and prescribed strong painkillers for 4-6 weeks. These had no effect and I stopped taking them after three weeks. A week later persistence on the phone was rewarded with a face-to-face consultation with another GP I’d not met previously.
This consultation was excellent. A diagnosis of polymyalgia was judged likely, blood tests organised, steroid treatment commenced after the test results, and a referral to a consultant rheumatologist, Dr XXXXXXX from XXXXXXXX Hospital, made, all this within a couple of days. The GP noted that the steroid treatment would ‘play havoc with my glucose levels’ (I have type 2 diabetes). The same GP arranged a phone call to check how things were going.
I duly saw Dr XXXXXXX who has since overseen treatment and care for the polymyalgia. This has resulted in a series of hospital consultations, face-to-face as well as by phone, plus innumerable blood tests. What surprised me was that there was no attempt by the practice to follow up on the management of my diabetes. This came to a head when I attended the XXXXXX at XXXXXXXX for a precautionary scan and was told my glucose level was much too high to proceed.
I am copying Dr XXXXXXX into this letter but should emphasise that she is not a party to it, has not seen it in advance, and its contents are mine alone. My sense, however, is that it has fallen to Dr XXXXXXX, with me acting and a kind of self-advocate, to try to secure an organised practice response to the management of my diabetes. I briefly saw yet another GP I’d not met before and had a phone conversation with a pharmacist who said she’d arrange to bring forward a diabetic review; she said she’d text me the details, though in the event she didn’t. In the meantime, Dr XXXXXXX arranged for me to see another hospital consultant at XXXXXXX Hospital to sort out my diabetes medication.
It has, in short, been difficult to secure any kind of continuity of care. Even securing a blood test at the practice to render yet another drive to XXXXXXXXX Hospital unnecessary was hard work. I was told it was an eight-day wait. In the event my persistence prevailed once more but it was far from a given.
This patten of events is common across the country of course. GP surgeries and the provision of a full range of services have become a real challenge for doctors, nurses and allied professionals. What we once took for granted is no more in the ‘new normal’. At the age of 73 I recall with nostalgia a time when you could see your GP any day simply by turning up and queuing, or indeed have a home visit, and s/he could refer you to any hospital specialist in the country.
You will know just why the XXXXXXX Medical Practice has no fewer than twelve GPs on its books and yet it is so difficult for patients to achieve a face-to-face consultation. I have noticed that the waiting room is often virtually empty with scarcely a doctor around at times when it would have been bustling a short while ago.
I taught medical students and doctors at UCLMS for half century, not least about the changing nature of health care systems. My reading of the circumstances in which you and your colleagues find yourselves is, very briefly, this. The NHS has been systematically underfunded to create growing public/patient dissatisfaction so that for-profit providers can be presented as the cavalry called upon to rescue it. The Centene/Operose incursion into primary care is but the thin end of the wedge; and patients at their practices are experiencing real problems. I think you and your colleagues are between a rock and a hard place.
I am writing this ‘supportive’ letter because I feel strongly about what is happening to the NHS. Reading the small print, the introduction of Integrated Care Systems under the Health and Social Care Act of 2022 likely marks the end of the NHS as we know it. We will in all probability see more rationing, care becoming something of a postcode lottery, the NHS becoming a kitemark for private providers, etc. It is even possible too that people’s assumptions of NHS entitlement and cover will be found wanting in the future as they move from one ICS to another. I could go on.
I am sure this is all stressful for everyone working in the NHS, the more so if they are aware of the politics. It is of course stressful for their patients too. Patients, as you will know only too well, are now angry when they can’t see ‘their’ GP, or indeed any GP. Receptionists too are in the front line. What I would say is that we patients are right to be angry at the effective termination of continuity of primary care and at what is without question a deterioration in the service, with worse to come. The problem is that few patients either realise the constraints within which you work or that this is all a predictable consequence of the political strategy deployed by central government.
I would like to see blame apportioned appropriately. In particular I would personally like to see pithy posters in every NHS surgery and clinic explaining that staff are doing all they can to meet growing patient demand, but that services have been impacted by central government underfunding, which has long affected staffing levels, hospital beds etc, but which has been made worse by restraints on doctors and nurses trained overseas, COVID, practitioner burn out, exhaustion, and so on. Might something like this be desirable/possible? I think health workers and patients should be united in standing up for the NHS.
Very best wishes,
Graham Scambler, Ph.D, FAcSS,
Emeritus Prof, UCL,
Visiting Prof,
Surrey University.
- Dr XXXXXXX