My partner’s father is 88 and earlier this year his health began to deteriorate. Over a three-week period, we repeatedly requested a home visit from his GP without any success.
In the end, he said a stroke and has now been in hospital for six weeks. I think it highly likely that this outcome could have been avoided if a doctor from his local practice, someone who knew him or who had access to his medical history, had been able to visit.
Sadly, experiences such as this are becoming increasingly common as the NHS struggles to return to ‘normal’ service after the pandemic. Yes, waiting lists are soaring — currently at 6.4 million and counting. Many A&E units are stretched to breaking point, while ambulance response times grow and staff shortages worsen.
A key factor in this looming meltdown is the calamitous state of general practice. Once a central pillar of healthcare in Britain — GPs are the gatekeepers of the NHS — its foundations are crumbling.
The needs of the public are no longer being met, while the core principle of free access for all is under threat as never before.
In the last week alone, two reports have laid bare the scale of the deterioration in the provision of primary care.
On Monday, the Mail revealed that in the worst-hit parts of the country, more than a quarter of consultations with family doctors now take five minutes or less.
And across England, out of 3.5 million consultations in April, only half lasted more than ten minutes.
A key factor in this looming meltdown is the calamitous state of general practice
This study came in the wake of another depressing analysis showing that the number of people turning to private GP services has increased dramatically in the past two years.
According to a newspaper poll, no fewer than 1.6 million people have paid for a private consultation for the first time amid growing disillusionment with the service offered by NHS GPs.
In truth, this should come as no surprise. The British Social Attitudes survey last year found that just 38 per cent of patients were satisfied with the performance of their local practices, a staggering drop of 30 percentage points since 2019 and the lowest level since the survey began almost 40 years ago.
As an NHS GP myself, I despair at what is happening and understand the frustrations of the public.
But unless action is taken, I also fear the crisis will accelerate the emergence of a two-tier GP service, with those who can afford to pay for an appointment getting first-class care from doctors — whose training, don’t forget, is funded by the taxpayer — while the rest of the population has to settle for an inadequate ‘safety net’ service.
I have sympathy with those who feel compelled to seek private consultations. However, my own experience of working for one of the big commercial providers of GP services gives me pause.
My first objection is that the system smashes the central ethos of the NHS — that care should be free at the point of delivery, available to all regardless of their wealth or income.
The appointment fee of £40 charged by the company I worked for may have been affordable to middle-class patients, but it was well beyond the reach of the disadvantaged, or pensioners on a fixed budget — the people who are likely to have the most serious health problems.
As the cost-of-living crisis takes hold, that is even more likely to be the case now.
As an NHS GP myself, I despair at what is happening and understand the frustrations of the public
In addition, the quality of care provided by private GPs is often limited by an inability to access NHS patient records.
Moreover, the doctor-patient dynamic changes when payment is involved. The patient becomes the client, and doctors can find their authority undermined as demands may be made for certain kinds of treatment.
I also believe that the growth of the private sector brings into question the huge funds invested by the taxpayer in training NHS doctors. Should private firms scoop the rewards of this investment?
I am not against choice — those who want to seek private treatment from a GP or consultant should have the freedom to do so.
But unless there is a radical improvement in NHS GP services, this is a trend that will accelerate and imperil access to primary care.
So how has it come to this? One reason, I believe, is that our engagement with the public is becoming far too limited.
At my own practice, we are able to offer appointments that last 15 minutes, which is the minimum amount of time needed for a proper consultation. Anything less than ten minutes is far too short, in my opinion, as it is often only in the last five minutes that many patients will have the courage to voice their real health concerns.
I have sympathy with those who feel compelled to seek private consultations
A system which offers appointments every five minutes opens itself up to the danger of incorrect diagnoses or inappropriate treatments.
And the idea of a consultation lasting less than five minutes is just absurd — that is barely time to write a prescription or referral note.
Covid did not help, of course, facilitating the move to appointments conducted over the phone or via Zoom. Indeed, face-to-face consultations are becoming a rarity. But telephone appointments are often an inadequate substitute, particularly for the most vulnerable.
Even worse for many elderly patients with limited computer skills are so-called electronic consultations, or e-consultations, which can create anxiety rather than provide reassurance.
I have also seen firsthand the impact of patients struggling to make any kind of appointment in the first place when doing weekend shifts in a local A&E department.
Recently, I saw a patient who asked me to talk him through the results of some routine blood tests.
‘But this is Accident and Emergency,’ I told him. ‘That is really a job for your GP.’
‘I know, Doctor,’ he said. ‘I have tried and tried, but I can never get through on the phone. That’s why I am here.’
So I explained the results to him — a straightforward task but one that had no place in A&E.
However, my own experience of working for one of the big commercial providers of GP services gives me pause
Incidents like this don’t help the ambulances queuing up outside, unable to offload patients who may be in dire need of treatment, due to an influx of people who have turned up because they are unable to access their GP service.
Most will have legitimate concerns — but not concerns that require the input of a hospital consultant.
I fear for the future of the GP service, and worry about two possible outcomes: first, primary care could be transferred wholesale to the private sector, taking us back to the grim 1930s where access to healthcare depended on the ability to pay.
Or, second, general practice could be fully nationalized, with family doctors made employees of the state under the direction of NHS managers.
In fact, the Health Secretary Sajid Javid has openly canvassed support for this option, under which GPs would lose their autonomy and flexibility.
Neither outcome is desirable. A more sensible option would be to address one of the key problems in this crisis — a part-time, female workforce.
Like almost 60 per cent of British GPs, I work three days a week. I chose this career path in medicine, because I was explicitly encouraged to do so by the Government in the belief that it allowed me to juggle raising a family with the work I love.
But with an aging and expanding population, demand for primary care is outstripping supply and the system is buckling as a result.
We need to ease the pressure on local practices by training more doctors and recruiting more GPs — starting now. Only then will patients get the service and care they need and deserve.
Dr Hoenderkamp is a GP in London.