GPs are being blamed for government failures in primary care, say doctorsBMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2234 (Published 13 September 2021) Cite this as: BMJ 2021;374:n2234
Over the past few weeks a significant chunk of the UK national press have been running anti-GP articles consisting mainly of two messages: lazy GPs are refusing to see patients face to face, and practices have been closed during the pandemic. Both accusations have been clearly refuted by medical leaders, with data showing they are unfounded, but why is there so much anger at primary care?
Animosity towards healthcare workers is not a new phenomenon in the covid-19 pandemic. For many months healthcare staff have had to face protesters outside their workplaces and been subject to physical and verbal abuse, even receiving calls for them to be hanged. However, the media vitriol against general practice has recently ramped up.
Headlines have included the Telegraph’s “GPs still ignoring orders to allow patients face-to-face appointments” and the Spectator’s “Why are doctors still hiding behind Zoom screens?”12 Some articles, with support from a small number of secondary care doctors, have even gone so far as to blame GPs for excess deaths. A Times headline claimed that “Virtual GP visits are ‘costing lives.”3
However, workload statistics tell another story. They show that practices in England delivered 31.1 million appointments in June 2021, of which 4.2 million were for covid vaccinations.4 This was 7.3 million more appointments (or 3.1 million more, excluding covid vaccinations) more than in June 2019 (23.8).5 More than half (56%) of the appointments in June that weren’t for covid vaccinations were face to face.
Writing in BMJ Opinion, Martin Marshall, chair of the Royal College of General Practitioners, said, “There’ve been numerous times in the past when GPs have unwittingly become the target of media criticism, but the current onslaught is the worst I can remember in over 30 years of being a GP. As well as being offensive and inaccurate, it is also irresponsible as it poisons the relationship that GPs have with their patients and undermines the trust and confidence they have in us.”6
What’s even more confusing for many GPs is that the push for more appointments to be virtual came from the government long before covid-19 emerged, and during the pandemic both NHS England and then health secretary, Matt Hancock, pushed for all patients to be triaged virtually, with Hancock even saying that all appointments should be remote by default.7
There is an issue
Something that patients, GPs, and secondary care doctors seem to agree on is that there is a problem with access to healthcare. However, while some in the media blame GPs, medical leaders have said the real problem is that successive governments have failed to appropriately fund primary care, which handles around 90% of patient contacts for less than 10% of the national health budget. This, coupled with the huge stress put on services by the pandemic, has left general practice struggling to meet the ever increasing demand, with fewer doctors.8
The BMA has reported that the number of patients per practice is 22% higher in 2021 than it was in 2015 but that the GP workforce has not grown with this demand. As a result, there are now just 0.46 fully qualified GPs per 1000 patients in England, down from 0.52 in 2015.9
The chair of the BMA’s General Practitioners Committee, Richard Vautrey, told The BMJ, “GPs share and understand the frustration of patients who are struggling to be seen at their practice, but blaming individual GPs is unfair. And making hardworking family doctors scapegoats for years of government failings is completely unacceptable. GPs and patients are on the same team, and we despair at attempts to drive a wedge between us and the people we care for.”
“The real issue is that we are now seeing the fallout of over a decade of underinvestment in our service,” said Marshall. “Successive governments have allowed GP numbers to fall, while the volume, and complexity, of patient demand has risen and continues to do so.”
He added that the media “can play its part by campaigning to save general practice rather than plunging it further into the abyss.”
However, Michelle Drage, chief executive officer of Londonwide Local Medical Committees, the umbrella body that represents GPs in the capital, said that the current narrative was intentional.
Writing in an update to GPs she said, “This is not the result of a silly season spree by the media. It is part of a sustained denigration of our role. It’s political. It’s been briefed. Were that not the case we would see the secretary of state for health and social care, and the chief executive of NHS England and NHS Improvement, publicly pushing back and supporting us and our teams. We would be seeing clear messages to the public, and we would see GP contract monies and resources directed to our core services to enable GPs, nurses, and admin staff to do our job properly and safely.”12
Correcting the narrative
While GPs are themselves trying to correct the narrative, including by reporting the Telegraph to the media regulator,13 and speaking out on social media, many want to see the government and NHS England support them.
In a joint letter to health secretary Sajid Javid on 9 September, the BMA, Royal College of GPs, Institute of General Practice Management, and NHS Confederation said, “Currently, [staff] are being repeatedly attacked, insulted and scapegoated across the media. This situation is not acceptable. We call on you to publicly support and defend dedicated GPs and primary care staff against this onslaught of misinformation and abuse promoted by the media.”
They have called for “accurate, timely and regular communications from the government to the public” to convey the realities of the situation, especially relating to general practice. “The primary care workforce has become increasingly demoralised by the current situation and we risk losing many of them, which would make matters even worse,” they warned.
Speaking to The BMJ, Vautrey added that both NHS England and the government had a “responsibility to the public to challenge this damaging and inaccurate narrative.” He has called on patients to support the BMA’s campaign by signing its petition to the government demanding the funding and commitment needed to provide practices with the resources they urgently needed.14
“Both GPs and patients deserve better,” Vautrey said.
Working in the storm
Neena Jha, GP with a special interest in emergency care who works in both primary care and emergency services in Stevenage, said, “It’s just utterly demoralising, and I know that word has been played around with the past year and a half, but it’s true. It’s just utterly demoralising. And it’s so frustrating because a lot of it is just completely false. We’ve had higher and higher workloads, and the burden of that is being shared across fewer and fewer doctors. It’s completely unsustainable, and to work so hard and see comments constantly from some media outlets and on social media, you feel completely and utterly beaten down.”
View from secondary care
Zack Ferguson, an acute medical registrar in London, said, “We’ve all had to adapt rapidly to the pandemic, but staff in general practice are the only ones called lazy for providing more services virtually, even as hospital doctors are praised for doing the same. People are understandably frustrated at how difficult it is to see their GP face to face, but this is nothing new: the resources allocated to GPs to deliver the lion’s share of the NHS workload are clearly inadequate . . . It’s devastating to hear of GP colleagues receiving abuse and threats of violence. That certain MPs, journalists, and retired colleagues with no experience working in primary care are stoking these flames instead of calling for more funding is reprehensible.”
Jacky Davis, a consultant radiologist at Whittington Hospital in north London and a founding member of Keep Our NHS Public, said, “There are always those in the right wing press ready to bash the NHS, and now it’s the turn of GPs. The media have given plenty of attention to the heroic acts of hospital staff during the pandemic but haven’t acknowledged that GPs have also struggled hard to keep services going . . . We need those in primary and secondary care to stop blaming each other and come together to demand a properly funded and fully staffed NHS.”
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