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News NHS Crisis: Voices from the Front Line

GPs left in unsustainable position by “brutal” number of requests

BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p93 (Published 12 January 2023) Cite this as: BMJ 2023;380:p93
  1. Emma Wilkinson
  1. Sheffield

In many ways, Birley Health Centre on the southeast edges of Sheffield is bucking national trends. Since 2020 it has increased clinical workforce capacity by 16% and has an above average number of GPs per patient. The practice has invested in reception staff, and about 70% of patient requests now come through AskmyGP. More patients are seen face to face than request it, and the team, which includes two physician associates, clearly have job satisfaction.

But they are working flat out all day every day to manage their 8850 patients, coming in early and leaving late. Over the past week they have frequently had to turn off AskMyGP hours earlier than the usual 1 pm cut-off because of demand.

GP partner Ben Allen, who is also director of primary care for Sheffield, said that on 6 January he left it on longer because he wanted to offer a good service for patients but then had to work until 8 pm dealing with a “brutal” number of requests. Endless blood test results, discharge letters, and other admin queries are dealt with among ongoing total triage and appointments. There are also two care homes to manage.

Changing priorities

At the moment some of the chronic disease management and medication reviews, which the team is keen to get on top of, are having to take a backseat to very high urgent demand—a lot of flu, strep A, poorly children, and people with sickness and vomiting, as well as strokes, heart attacks, and other serious illnesses.

“Whether we get paid is based on [the Quality and Outcomes Framework] but at the moment we’re having to prioritise urgent demand at the expense of that,” said Allen. “It affects the ability to look after the chronically unwell and housebound people. There’s a trade-off between meeting the needs of people ringing up saying I want to see a doctor and looking after the people with long term conditions who will often need quite long appointments. And they’re not the ones knocking on our door saying we need to see you.”

Charles Heatley, a GP partner at the practice, said that he can barely speak when gets home at the end of the day because of mental exhaustion. “That’s why it’s unsustainable, you can’t do that forever,” he added. It was hard to explain why the demand was so much higher, he said, but it’s likely to be lots of smaller things adding up, including managing patients who are on long waiting lists, dealing with queries from expedited patient discharges, and increased mental health issues.

“In the last few weeks, we have had a registrar cover my usual on call to give me time to do some diabetes work,” said Heatley. “People’s ability to manage their diabetes has been really affected by covid. This week I can’t do it because we’re two doctors down. Organisationally we’re trying very hard to get back on top of that, but it’s very hard to do.”

Burn out

Over on the opposite side of the city, 10 minutes away from the sprawling Northern General Hospital, Susie Lupton is a GP partner at Norwood Medical Centre where she’s worked for 20 years. In this very deprived area, long term conditions are a huge part of the job, as well as a high number of care homes. Partners are working “gruelling” 12 hour days to cope. “Our whole team has been burnt out. We can’t actually give any more, yet we seem to still be getting the blame for anything and everything,” she said.

“GPs have been telling governments for over a decade that urgent action is needed to address a looming disaster in the workforce, but we have always been dismissed as bleating GPs,” she said. Premises are also a problem. The practice has increased from seven to 12 consulting rooms over the past decade and simply cannot physically offer any more appointments.

“Even though we are sited half a mile from Sheffield’s [emergency department], our patients are very reluctant to go and it is a weekly occurrence to get them walking in having a [myocardial infarction], stroke, needing oxygen, or with sepsis,” said Lupton. Recent antibiotic shortages amid concerns about strep A caused particular headaches for the practice and “wasted many GP hours that could have been spent seeing more patients.”

She wants to see the government tackle staffing, fund social care, and set policies to help tackle health inequalities. “We have not created this mess, and yet we are working ourselves into an early grave doing the absolute best we can with the tools we have,” she said.