Inside a busy GP surgery: From daily abuse to the face-to-face debate
- Credit: SARAH LUCY BROWN
GPs are coming under fire with a war of words erupting about a lack of face-to-face appointments. Emily Townsend goes behind the scenes at one Ipswich surgery as part of our series into the crisis facing the NHS.
There was once a time when a doctor’s waiting room could capture the health of a community. Pre-pandemic, patients rich and poor, young and old would all flood through the door.
Fast-forward to 2021 and that picture is totally transformed.
At 10am on a Monday, a mother sits, distanced, in the centre of Barrack Lane surgery’s waiting area with her 13-day-old baby.
Two pensioners, brought by their daughter, chat with nurses - their voices slightly muffled by protective visors.
A handful of other patients wait quietly, wearing face coverings still mandated by the NHS - the room mostly silent aside from a relentless ringing of phones from reception.
A few moments later, the silence is suddenly shattered.
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Shouting and swearing, a mother - having passed a sign politely asking patients to wear masks and social distance, bursts in shrieking at staff to “f**k off” - before storming out onto the street.
Receptionists had asked the woman, seeking treatment for her son, to wear a mask indoors to protect others - and she refused.
Penny Ashbee, who has managed the Ipswich practice for more than 30 years, said the usual protocol is to call back, then write to the patient telling them their behaviour was unacceptable.
But she explained repeat offenders will be taken off the list: “We’re quite tolerant, I accept if someone’s having a really bad time and is unwell, sometimes they get a bit anxious.
"Those people will normally ring you back and apologise."
Staff facing ‘daily abuse’
Reception staff, fielding scores of calls on everything from prescription queries to mental health emergencies, say they are abused every single day.
Abuse tends to be over the phone, with most people frustrated about waiting in a queue.
Wai Mun-Jones, whose three-year career with Barrack Lane has largely been during Covid, stressed that patients rarely get violent.
But she revealed there was one occasion in the height of the pandemic when urine was thrown through a window designed to help treat Covid patients.
“We try our hardest," Mrs Mun-Jones said. "A lot of patients will say ‘we’re so far into the pandemic, why can’t we see a doctor face-to-face?'
“The pandemic’s still happening - it hasn’t ended, but here, if the doctor feels like they need to see you, they definitely will invite you in. They won’t leave you.”
GPs ‘not hiding behind doors’
‘Let’s get back to seeing GPs face to face’, warned a Daily Mail front page in September, detailing tragedies of missed diagnoses and sparking a tense national debate.
The next day, a “powerful intervention from Downing Street” followed, as Boris Johnson’s spokesman said every patient had the right to an in-person appointment if they wanted one.
Then on Friday health secretary Sajid Javid announced more funding for GPs, told them to see patients face-to-face and pledged to publish more data about their performance.
That provoked a backlash from the British Medical Association, which represents GPs, who claimed the Government was “out of touch” with the GP crisis.
Before Covid about 80pc of all GP appointments in Suffolk and north Essex were face-to-face; that is now around 60pc.
Dr Debasish Banerjee, senior doctor at Barrack Lane, admits that there are some surgeries that are not seeing enough patients.
But he added: “There is a growing perception that GPs are being villainous and that GPs are hiding behind doors.
“The reason I said yes to this meeting is because I wish the media would work with primary care to dispel this myth."
“The evolution of remote working in the NHS started well before Covid," he said. "But Covid put us on a rollercoaster, where you had to do it, because there was no way out."
While surgeries have had to adapt, providing patients with a tool to upload pictures of more simple ailments such as skin rashes and at-home blood pressure monitors, Dr Banerjee said that for any clinician, the preferred choice of consultation is face-to-face,.
But he added people had to be prioritised.
"It’s the ability of a system to choose to see the right person at the right time with the right symptom," he said.
"If you put a patient with a little bit of snot in front of me, a GP, I’d rather see someone with heart failure."
‘People think we were closed’
NHS figures for August show around a third of appointments with Suffolk and north Essex GPs are over the phone, with the remainder face-to-face. A tiny amount are held over video link.
Barrack Lane primarily offers on-the-day appointments and on the Monday we visited it had 258 consultations to allocate.
“We’re offering all types of appointments, we have been all through Covid, and that’s what makes me a little bit cross - people think we were closed, we were not,” Mrs Ashbee said.
“Basically here, you phone, you talk to a well-trained navigator at reception, they will ask you a couple of questions and direct you to the appropriate person.
"It’s not always about the doctor. You need them when you are really sick, but for lots of more minor things, we’ve got other people.”
Paramedics, pharmacists, advanced nurse practitioners and community midwives are among staff members at Barrack Lane - it has almost 20,000 patients on its books and six full-time equivalent GPs.
Behind the scenes, an expert team prepares prescriptions, answers hospital letters, handles medical records and even repairs IT equipment.
“GPs have become very precious - there are not many of them around,” Mrs Ashbee added.
“The training hasn’t been there over the years and so there are not the GPs coming down the line.
“Years ago, if your list size got above 1,400, you were given a GP and the finance for it.
“So if you needed a new GP, you built your list up and applied for one. Now, there’s no limit to it (the list).”
NHS figures show Ipswich and East Suffolk has one GP for every 2,300 patients, one of the highest ratios in east England. But West Suffolk is one of the best served in the country with one GP for every 1,700 patients.
‘You are 35th in the queue, please wait, someone will be with you shortly’
One of the major gripes the public has with accessing GPs are telephone queues for appointments.
Demand for consultations has surged to a point where Mrs Ashbee wonders whether queue numbers should be taken off the system.
“People say I was 35th in the queue. Well if you’re 35th in the queue and seven people are answering the phone, you’re only fifth in the queue,” she said.
“This morning, you’ve got eight or nine people answering the phones."
Barrack Lane now has a system where patients asking about prescriptions can phone up between 10am and midday - which has whittled down a few callers.
But Mrs Mun-Jones said receptionists still feel they are fighting a losing battle.
“Mondays are particularly horrendous. You just feel like you’re not winning,” she added.
“People are upset that they’re waiting so long - but sometimes they don’t know why. I could be on the phone to someone who wants to take their own life - and that call is not going to last 10 seconds.
Pressure on the practice is just going to continue ramping up in the next few weeks as winter looms, Mrs Ashbee said.
Complexity of illnesses has led to the surgery increasing appointment times from 10 minutes to 15.
“It’s almost as if it’s the middle of winter already,” Mrs Ashbee added.
“The hospital is very behind, it’s nobody’s fault as they had to shut their doors and do things differently.
“So lots of patients are ringing up saying they’re still waiting (for hospital treatment) and asking for extra painkillers.
“It’s all very well patients getting cross with us for doing these things but they’re not my decisions - it’s the NHS telling me what to do.
“And I think sometimes they (NHS England) don’t step up and say ‘we told them to do that’, they don’t back us sometimes and I think that’s important.”
Can the NHS survive?
As the single largest practice in East Anglia that is not part of a merger, Barrack Lane has five GPs in training - something Mrs Ashbee hopes will safeguard the future of general practice and the NHS.
“If we’re not training these people to come down the line, you’re not going to have them in five year’s time,” she said.
“Everything in the NHS is very short term and unfortunately it is political as well.
“There are issues around training because no-one wants to put the money to it.
"It means there’s a very small pot of people being trained and everyone wants to grab them.”
Being a training practice means Barrack Lane is less likely to experience problems recruiting clinical roles - but applications for administrative jobs have slumped.
Mrs Ashbee hopes they reach a point where surgeries can offer patients a package that “works for everyone”, a mix of online and face-to-face contact from a variety of experts, including GPs.
Dr Banerjee said he can understand why patients have felt the way they have felt about general practice during the pandemic.
“Demand for general practice is like an avalanche which is not settling down," he said.
“I think the question we’ve all had to ask ourselves in the past year and a half is, how do you fight catastrophe, how do you fight things you’ve never seen before?
“I know that here, we’ve certainly tried to do the best we can.”
They must be getting something right. In the latest GP survey for this year around 70pc of patients in Suffolk said they were satisfied with GP appointment times.
Read more from our NHS On The Brink series:
Tomorrow: Paramedics on the brink as mental health leave breaks records