Is it just me or does it sometimes seem that the entire NHS system is focused on A&E and waiting times and not a lot else? As a GP I don’t get a look in. The only time it seems that GPs get mentioned is in the context of ensuring we have enough capacity to see patients to avoid them going to A&E. When do we hear about GPs being of value for what they do for their patients, rather than just as an admission avoidance service? Writing this around Christmas it currently seems even more relevant. With system Winter Plans in full flow, the focus on GPs seems to be just about how we can play our part to keeps the hoards from the Emergency Department front door. Where is the Christmas Cheer for GPs? Where is the acknowledgment of the work we are doing? If I look under the tree on Christmas Day will there be anything there for GPs?
This is not the first time I have written about General Practice, and I am sure it will not be the last. I fear that views are not changing though.
Two years ago I delivered a TEDx Talk about the value of the Generalist. You can watch it here: https://www.youtube.com/watch?v=-BfcvI49GCw. If you don’t have time to watch the 16min video, then here are the headlines:
- Society values Specialists over Generalists.
- Generalists themselves find themselves feeling ‘second best’.
- Nevertheless, Generalists often possess skills of great value – ability to think outside the box, ability to connect seemingly unrelated facts, ability to make sense of complexity.
- Generalists should embrace their calling and promote this as a vocation.
- I use a powerful patient story to make my point.
(Why don’t you go watch it now – you know you want to..)
So, why don’t GPs feel valued in the NHS? Sometimes it feels as though we are invisible, or worse still causing rather than helping with problems.
I was at our local A&E Delivery Board yesterday. NHS 111 were present to talk about their service. Repeatedly it was said that patients sometimes/often ring 111 because ‘they cannot get an appointment with their GP’. This gets taken as fact and the conversation continues to ask whether people present at A&E because they cannot get an appointment with their GP. No one stops to question whether this ‘fact’ is actually true – no one asks the GPs whether they are turning people away. I know they are not (in the vast majority of cases). I know they are offering appropriate appointments for patients and adding extras to clinics where it is clear people need to be seen that day and cannot wait. I interjected with some numbers.
The surgery I work at covers a population of about 10,000 patients. Last Tuesday morning we received 177 calls into the practice between 8am-2pm. We typically offer 600 face to face appointments with a GP each week (this does not include phone calls, nurse appointments or home visits). Let us make some assumptions and scale this up…
NHS Vale Royal CCG and NHS South Cheshire CCG form a natural health economy locally in Central Cheshire. Together they cover a population of around 275,000 patients with 29 GP practices (147 GPs total, many part time). If my practice is typical it means that across Central Cheshire GP Practices receive around 4,800 phone calls every Tuesday morning and offer about 16,500 face to face GP appointments every week.
The numbers are huge. I just don’t think people realise how much work is being done by GPs. How much care is being given, the vast majority of which is dealt with at the surgery and never seen anywhere else.
So, when I see ambulance reports saying that GPs MUST be available to speak to paramedics to avoid admission and that GPs SHOULD adjust their surgeries to avoid clustering of ambulance requests following morning visits, I get a bit frustrated. (https://twitter.com/DrJonGriffiths/status/1075370498366816256) I just don’t think people who suggest these things have any idea of the amount of work being done. I don’t think they have any idea of how efficient General Practice already is and how well we are caring for our patients. All of the above seems to be expected of GPs within our current funding resource. We have seen precious little of the fabled ‘left shift’ which everyone talks about – where we move clinical work away from expensive hospitals and into the efficient community. The work has shifted, the resource to follow it has not. No Christmas presents for GPs here.
We need to get on the front foot with this. As GPs we need to be standing up for ourselves and shouting about how good we are, and how much work we are doing.
There are GPs doing this of course, it’s not just me!
I just want to add my small voice to the noise that I feel we need to generate. If you are a GP, I would encourage you to start to speak out as well. I’m not looking to make negative noise and disruption, just to be positive about what we do, and promote our value.
We need to see more blogs about the value of General Practice, we need more TEDx Talks about it and more positivity! Only when the whole system starts to see what General practice is already doing will people start to realise that joined up conversations are needed, not instructions for us to work harder or in different ways without any prior consultation.
GPs need to step up and play a role in local health and care systems. If we do this in collaboration with our system colleagues, I truly believe that great things can happen.
Why don’t you do what you can to help this, and perhaps send out some love to your local GP this Christmastime…
Dr Jonathan is a GP in Cheshire and Chair of NHS Vale Royal Clinical Commissioning Group
Find Jonathan on Twitter @DrJonGriffiths