Rammya Mathew: Keep caring, even when it’s hard

Until recently I thought that primary care had earned the top spot as the Cinderella of the NHS, undervalued and neglected. But now that I’m working for a large community trust I have a much broader view of what’s happening across the NHS. I’m increasingly concluding that the entire health system has reached boiling point. The huge mismatch between capacity and demand is hitting the health service from all quarters and wreaking havoc, particularly in our frontline services.

Within half an hour of the phone lines opening, GP appointments in most surgeries are booked up for the day, leaving many patients feeling frustrated and short changed. This inevitably has a knock-on effect on other services, often being cited as a major cause of “inappropriate attendances” at emergency departments. But there is in fact two way traffic: patients who should be seen in A&E are also being forced to seek help elsewhere because of long waiting times.

This week I’ve been told that our local walk-in centre, which doubles as a minor injuries unit, is frequently at maximum capacity, as patients who have waited for several hours in A&E are coming to the walk-in centre out of desperation. This then hits us downstream in primary care, with patients redirected to GPs by the walk-in centre when it closes its doors to new patients because of extreme demand.

The mantra of patients getting “the right care, at the right place, at the right time” seems out of reach in the context of what I’m seeing and hearing on the ground. Many of our patients are on a merry-go-round, trying to navigate a health service that’s bursting at the seams, having to do what they can to get their needs met. It’s also hard on the clinicians and administrative staff, as we bear the wrath of patients who are rightly upset at being sent around the houses when they’re ill, afraid, and in need of help.

We can make endless attempts to improve signposting, use expert care navigators, and streamline access to services through NHS 111, but these efforts are all pointless if the services don’t have anywhere near enough capacity to see to the patients who need them. I’m not hopeful that a new prime minister, a new health secretary, or another NHS reorganisation will tackle the rising cost of healthcare or solve these seemingly intractable problems around capacity and demand.

For now, I’m telling myself and my teams to just keep caring, even when it feels hard to do so. All we can do is try to make our interactions with patients as smooth as can be, because what happens either side of that is simply out of our control.