During the pandemic, GPs adopted a new system designed to reduce the number of patients who could see or speak to their doctor. Devastatingly effective on its own terms, it was equally devastating for the health of patients. Yet there is no sign that this ’emergency’ measure is going anywhere, as doctors get used to a reduced level of contact with patients. Former NHS cancer surgeon J. Meirion Thomas writes about the problem in the Spectator.
In March 2020, as the health service prepared for the first Covid wave, NHS England encouraged GPs to adopt a new system called ‘total triage’. The aim was to reduce the number of patients in clinics in order to protect GPs, their staff and patients themselves from the virus. If patients hoped this system was a temporary, emergency measure, they were wrong.
Under ‘total triage’, patients had to provide far more details of their (sometimes sensitive and embarrassing) symptoms to a receptionist or on an e-consultation form. They would then be allocated a telephone consultation with their GP or another health professional such as a nurse, pharmacist or physiotherapist. In the first year of the pandemic, records show there were 90 million fewer face-to-face appointments – a drop of 40%. Of these, 70 million happened on the phone instead, but the figures still show tens of millions fewer appointments overall.
While Britain is moving on from Covid, many GP surgeries are emphatically not. It’s still quite common to see signs telling patients to go away unless they have booked an appointment via internet or phone. ‘Total triage’ has meant that GPs have had far less opportunity to examine patients, which has led to delayed or failed diagnoses. The burden of urgent care has rapidly transferred to A&E, where pressure has become intense. At the last count 24,000 patients per month had to wait for more than 12 hours to be seen. The reason is simple: general practice is broken.
Rather than acknowledge these problems, the unions – the British Medical Association and Royal College of GPs – insist that all can be solved by their long-term mantra of ‘more investment’. The Government has swallowed the bait and has promised 6,000 more doctors within two years. This unachievable goal is doomed to failure, as was Jeremy Hunt’s 2015 promise of 5,000 more GPs by 2020. Experienced GPs are leaving the profession in droves and medical students, after they complete their placements in general practice and see the insurmountable problems, are reluctant to fill the gaps. The number of fully qualified GPs in the NHS has changed little in the past three years.
And the patients? A recent poll by the British Social Attitudes Survey has shown that public satisfaction with GP services is at its lowest since the surveys began in 1983. NHS spending has trebled since then.
It doesn’t help, Meirion adds, that “an astonishing 58% of GPs work three days or fewer per week” and that one in three told a survey last year that they would like to quit direct patient care within five years. Nor that they haven’t had any contractual responsibility for out-of-hours care since 2004.
Worth reading in full.
Discussion
Comments
This week across the site:
To join in with the discussion please make a donation to the Daily Sceptic.
Profanity and abuse will be removed and may lead to a permanent ban.
Just look at the take up on this petition. And it runs out on 22 June.
If any proof were needed that GP is broken, then it’s the need for the wording in a petition like this.
https://petition.parliament.uk/petitions/603305
General practice is certainly in a mess (I’m a retired GP and pretty horrified) but I’m not sure that a retired surgeon with a chip on his shoulder is the best qualified person to diagnose the problems and propose solutions, his experience being based on a very restricted hospital based focus.
I can see lots of reasons for the problems we have, but no simple solutions
Well, if GPs can afford to work only three days in five, maybe we are paying them too much?
Gobsmacked! Phoned our Practice first thing this morning to try and request a triage call with a doctor. Recorded message: Practice is closed on Thursday 2nd and Friday 3rd for the Jubilee. We will reopen on Monday 6th. If your situation is urgent, call 999. If your condition is non life-threatening, call 111. Ta ta.
Wtf?!?
There are too many female doctors who are more likely to work part time: a long term problem that has been denied and certainly not addressed. Our old friend common sense tells us that this must be a contributory factor.
NHS have just released their new logo….
We’re living the era of managed decline, Agenda 21-30.
Besides their efforts to depopulate the planet, they’re so obviously beginning to restrict our means of travel.
Today another cruise ship has crashed (the longest in the world, no less). Cruise ships and cargo ships seem to be crashing all the time now. P&O Ferries, the biggest operator effectively killed itself.
Separately today, I overheard on the radio a report about the chaos of trying to book a driving test. Apparently the system is in meltdown.
Rail/tube strikes. Roadworks inexplicably scheduled at the busiest time of year, preventing people from getting to the station on time for their train.
Airliners inexplicably cancelling hundreds of flights at the busiest time of the year. Queuing system at airports causing enormous waiting times. Passport service in absolute disarray.
Petrol and diesel pricing inexplicably exploding. Road maintenance (everywhere that isnt outside an airport or trainstation) has completely stopped, with pot holes wrecking cars.
Surely – SURELY – people can see what is happening. Surely they’ve seen Pfeffel attending Cock26 in Glasgow, lecturing the world that we must change our way of life and stop travelling?
This is a managed decline.
It would seem that way, and whilst I can’t entirely disagree with you, if it is the case then someone is making a smash and grab at ‘environmental’ globalised governance over a very short period of time, unreasonably so.
Which means someone is in a hellfire hurry to get it done. And the concept of revolution rather than evolution comes from which political side? The left of course.
And which leftist global leader has a right wing opponent snapping at his heels? Joe Biden of course.
And the way things are going, Trump is a shoo in for a 2024 re-election, and he’s going to go after every single one of the ‘deep state’ from the day he’s elected, and they all know it.
Biden has two and a half years to pull off his plan to globalise the world, there’s only one problem. Vladimir Putin.
The ‘Mad Vlad’ has thrown a spanner in the works and is exposing the environmental underpinnings of globalisation for precisely what it is, a massive scam.
Putin is a big country, small nation guy, with an approval rating of 83% at home. When was the last time, if ever, a western leader had an… Read more »
This is the result of successive governments providing perverse incentives. If only we could have a government which f***s off and leaves us alone. I can’t see that happening any time soon.
Many of the type of people who become politicians are those who like to interfere in everybody’s lives – either just because they are busibodies, or because it’s in the financial interests of themselves or their mates.
Exactly so.
The curtain twitchers of the nation.
… they haven’t had any contractual responsibility for out-of-hours care since 2004.
Toni Bloody Blair: worst ever PM. Even Boris is less bad.
Blair started all this. Just turn up on Monday, 13th June at 1pm on Castle Hill, Windsor to express your anger at him receiving his knighthood on that day. If I were the Queen I’d miss with the sword.
Do an Anne Boleyn on him!
The practices seem absolutely petrified of humans. Triage/telephone is as far as I have gotten – and these were frustrating/disappointing experiences.
The Practice has recorded messages stating that it is imperative that you must not visit the surgery if you think you may have any covid symptoms. Another message begs the caller not to proceed with an actual triage call unless the need is urgent; you are then steered towards 111. The Practice message also whines about being short-staffed, and under great pressure. Well, I can’t feel sympathetic as a lot of the problems/issues are of their own making I think.
A couple of days ago, I did call 111. Their recorded message included a statement emphasising that, for the vast majority of people, covid is very mild and usually you will get better in a few days; that you can also get over-the-counter relief as per cold/flu, so no need to worry about it at all – unless you are very poorly.
111 says not to flap about covid: it’s a mere trifle for most. Why then, if you turn up at A&E, you are met with ‘MUST wear a mask’ signs everywhere?
I had to go to A&E after an accident 3 weeks ago. It was packed at 1 pm and had to wait over 3 hrs to be seen for a nasty but not life-threatening injury. The 3 people booking in in front of me should not have been there, each having some excuse for not seeing a GP, their obvious first port of call. The same was true of the 2 people either side of me when I sat down. There were frequent PA requests for people to go if their complaint was not serious but I only saw people leave on discharge.
A neighbour called an ambulance as she couldn’t get a GP appointment and thought by being trucked into A&E she’d get faster treatment.
if my experience is in any way representative then the system is broken. I can only see it getting worse.
FWIW once I was seen the NHS gave me excellent service, getting me patched up then operated on within 2 days.
I used to accommodate foreign students in my home. I would not do it now, because when they need medical care there is no longer a local doctor for them to see. Telephone appointments have a three week wait. No face to face appointments.
These young foreign women cannot understand why there is no immediate access to medical care in this country for things like normal sickness or headaches, things no-one in Britain would dream of being able to see a doctor for any more.
God knows what I would do if there were a true emergency, and I would be held responsible (at least morally) to their parents if something went wrong.
This has really brought home to me the parlous state of medical care in the UK.
Giving legal protection to the term “doctor”, so that only people who hold doctoral degrees from recognised institutions are allowed to call themselves “doctor”, would help improve the general culture in the country where health services are concerned. At the moment, anyone is allowed to call themselves a “doctor”, which is why medics don’t get whacked for doing it.
Have you had your jabs? No? Then get them. Your illness, whatever it is, won’t go away until you do. I will get you booked in.
You have had your jabs? Then your illness must be long Covid. Nothing to do with the jabs, which have saved you from getting it worse.
You see, I know how to play this game. So can I be a GP now please?
You know when a business has become too big and too bloated to operate efficiently, when it can afford to pay for the likes of external PR consultants, woke springs to mind but I’m sure there are many other examples. Put aside the word reset and replace with restructure, start with fattest, most bloated and most useless public businesses first.
Or diversity managers.
Indeed. Big business seems to be ‘bureaucracy central’. If you read the 2018 book ‘Bullshit Jobs’ by David Graeber, as he sets out, the rise in red tape has often been greater in the private sector than in the public sector. Counterintuitive, I know. He quotes figures from US state and private universities and elsewhere.
Yes, quite – the whole ‘diversity’ industry has balooned in the past decade, and on fairly high salaries too.
A few months ago I looked at the job adverts on the website of a small (less than 50 staff) wildlife charity. They were only advertising two, both part time but the full-time salaries were shown along with the pro-rata.
One job was leading a species conservation project – clearly required someone with strong knowledge and a fair few years of specialist experience.
The other was for an ‘Equality, Diversity and Inclusion Officer’.
Guess which one was on two grand more than the other…
Big business rivals the public sector in its waste and inefficiency. Same problem, better PR.
taxing on “profits” rather than charging for Patent and copyright protection leads to rent-seeking and the same problems as the current excess of government.
Look at the people who live next door to you and decide which one you would go to in an emergency. Hopefully you will have a healer amongst you. If you don’t then it’s just waiting for the miracle to come. I hope that you have been building up strong networks of resilience in you area because you will need to do so.
An alternative healthcare system is being built in the UK. They are currently fundraising so that an emergency response can be provided outside the NHS – West Midlands Ambulance service has stated that they will stop taking 999 calls from August.
– The People’s Health Alliance (the-pha.org)
How can an organisation with 1.7million staff disappear off the map?
They refuse point blank to pick up the phone or treat anyone
People talk about self-sufficiency but this is difficult in healthcare. You need a skilled surgeon and a clean room at least. I would avoid ideas of trying to develop rudimentary medicine from scratch. There is an episode of The Twilight Zone called ‘Time Enough At Last’. A frustrated bank clerk with literary aspirations suddenly finds that he has all the time in the world. And then his specactles break. There is no self-serving way out of this situation.
Don’t be so pessimistic! There is much that we can do for ourselves by making ourselves healthier & more resistant to disease. Excellent resources can be found at the World Council for Health & The People’s Health Alliance – For The People, by The People (the-pha.org) where there is also at a list of practitioners.
Community solutions is what is required.
GP is a non-job, and typically British. It’s similar to how the legal system is divided here. “Members of the public” aren’t considered worthy enough to be able to approach barristers themselves – they have to go through a “solicitor”. Similarly if you’ve got a pain in your foot and you approach a foot specialist (on the NHS anyway), his receptionist will tell you (as if you’re an ignorant cretin) not to waste the great man’s time, and to go to “your doctor”, meaning “your” GP.
Imagine if changing car tyres was organised like that. “You can’t come here without a referral. Go to your local car boy. He’ll tell you whether you need your tyre changed. Perhaps you only need a new wing mirror.”
Even the word “doctor” when applied to people who happen to be medics who have never been anywhere near making three-year long contributions to knowledge in an academic environment (or five-minute contributions for that matter) tells you a lot about Britain. They all keep straight faces too, as they allow people to believe that they’re real doctors. If they could get away with it, they’d probably have patients referring to them as “Sirs”, e.g. “Go… Read more »
The complete failure of the General Practice system in this country is another crime against humanity (us) that can be laid fairly and squarely at Bozo’s door.
He’s building one hell of a charge sheet.
I spoke with my uncled who is in his seventies and the things he told me about about getting old were very depressing. He said that when you’re young people will pay for your company but when you’re old you will have to pay someone to endure you. And the sense that you have to visit your doctor every month. We have made a very cold world for the elderly that are still alive and redemption should start with reversing this trend. It is the very opposite of the great reset agenda.
The GP’s were told don’t come to work we will still pay you
Try getting them off their backsides now
It’s like running through brick walls in some places trying to see a GP – except for when they have some Big Pharma product to push in which case they can’t see you fast enough
But, but if the Wah!NHS got 100% of GDP until the heat death of the universe is should be able to cope.
I can’t see the point of having a UK GP any longer, we’d get a better service if it were all done via the telephone from India … and it would cost a fraction of what they charge.
Yes and the language issue would be exactly the same!
My understanding is that GP practices are private businesses contracted to the NHS.
But unlike other private businesses they hold a monopoly over a certain geographical area so they have no competition.
When I recently moved 5 miles to another village I was forced to change from a practice I had used for 30 years to a another practice. Why?
No GPs have out of hours so it makes no difference to them. Most appointments are online/telephone. Which works well for me 9 times out of 10. I am self-employed and don’t lose half a day’s work travelling and sitting for an hour for an always late appointment in an overcrowded waiting room.
In distance I am only 1/2 mile furher from the practice which is still nearer than the one I have had to change to.
My previous practice was rated good, the new one requires improvement.
So why do they have geographical monopoly.
Why can’t we choose? This would mean better practices would be rewarded and could grow and poor one’s would have to up their game or fail or be taken over.
Like any private company.
It is another example of health care looking after itself so… Read more »
It’s extortion funded, so it’s run for the convenience of staff not benefit to patient.
There are private GPs in the more populous areas, particularly London, and they are not particularly expensive. I haven’t used the NHS for a very long time. There are also a number of online GP services now, not so good if only because they can’t run tests, but pretty cheap.
With the internet, there are lots of experts available if all you want is to stay healthy, mostly doctors and biochemists. Two examples of very many I’ve found useful are Dr. David Grimes (UK) and Dr Robb Wolf (USA).
One can search online for others’ opinions of them. In the current climate, comments such as ‘too close to known vaccine shills’ can be helpful in knowing who to trust.
As there are around here. But that was not the point I was trying to make.
You can register with any GP, as long as you sign away your rights to home visits.
Apparently this is not a universal rule in England as I asked and was told no.
Doctors are overrated.
Many African countries, following on from China, have found that resources are often better invested in paramedics with 6 months training. who actually visit sick people and have learned how the treat the ailments which make up the vast majority of cases.
You do need some doctors – but far fewer.
https://www.unicef.org/esa/stories/eritrea-revitalizes-barefoot-doctor-programme
Something like this could easily be implemented in western countries.
We already have this in the English urgent care centre system, or certainly in and around Leicester, Leicestershire and Rutland.
Both advanced paramedic and advanced nurse practitioners are able to prescribe. Also there are home visiting services where a paramedic, nurse practitioner or GP will visit a person at home if they’re unable to get to a UCC.
Theres no equivalent in either Wales or Scotland.
Thanks – didn’t know that.
It’s pretty uniformly dismal though…
That’s not fair.
I spent months being cared for at home by our ‘Hospital at Home’ team following an infected replacement hip, and they were fantastic. The concept is that they are based at the hospital you were treated at so you are not discharged. They have a direct line to your consultant so he/she knows what’s going on.
One visit to my GP some years ago was with a paramedic. He was very good, without the breadth of knowledge of a doctor, but only a call away from one.
We really must move on from demanding highly qualified doctors, being paid mega bucks per hour, for an ingrown toenail. It’s utterly ludicrous.
I have had far too many occasions when I have required the intervention of a medical professional. With a couple of notable exceptions I can truthfully state that diagnosis and treatment provided by a decent nurse is always way better than that of a doctor.
On behalf of my former nursing colleagues Thank you 😁
My wife has trained you guys for the last 30 + years and insists there is nothing like a good GP. And a good GP relies on an inquiring patient.
Sadly, GP’s are now required to diagnose and treat by tick box. Patients accept it, invariably without question.
Our health is our responsibility. GP’s are a means to an end.
Malcolm Kendrick illustrates this regularly.
I left this country in 1996 and returned in 2012.. In the early nineties the NHS wasn’t too bad at all in my recollection but after returning here I noticed a marked deterioration, compared with both the NHS as it was and with GP consultations abroad. The events of the last couple of years catalysed the entropy. Even before that time general practice was coming to be seen as less attractive than it once was. What are you, a customer service agent for drug companies who does his best to avoid referrals to more costly and less profitable interventions.
BTL comments in the Speccie are similar to those here.