Let us all see our GPs face to face again: Last November The Mail on Sunday first highlighted the fears of patients only allowed phone or video calls with their doctor… by February nothing had changed – nor has it now
- GP doors remaining largely closed is becoming increasingly incomprehensible
- Over past week, new Covid infections have fallen to an average of 2,000 a day
- Guidance on how surgeries should operate in pandemic remains firmly in place
- The Mail on Sunday has launched a new campaign to demand a shift in thinking
If there is one story which encapsulates the distress of families as GPs remain behind closed doors during this pandemic, then this is it. And to health chiefs who continue to insist patients should only be seen face-to-face where absolutely necessary, it should serve as a warning shot: to open up ALL surgeries again, or risk many more families being devastated, just like this…
It was October last year, before the second wave of the pandemic had taken hold, when Elaine Gordon contacted her GP practice in the North West.
Fit and healthy, and in her mid-50s, Elaine rarely bothered her doctor.
The former nurse, a devoted grandmother, was a full-time carer to her husband Mark, who has late-stage multiple sclerosis and is no longer mobile.
Her sister-in-law Sarah describes her as ‘robust’ and ‘the glue that holds our family together’. But she had become so unwell she was unable to get out of bed. In her groin was an unusual swelling.
The Mail on Sunday has launched a campaign urging NHS bosses to let us all see our GPs face to face again, after first highlighting the frustrations and fears of patients only allowed phone or video calls with their doctor last November
Her GP practice offered her a telephone call with a practice nurse, whose first question was whether she had had any new sexual partners. The insensitivity, given the practice’s knowledge of her husband’s condition, distressed Elaine so much that she put down the phone in tears.
Over the next few weeks her condition deteriorated rapidly.
She lost three stone in weight, was unable to stand for more than a few minutes and was covered in unexplained bruises and boils, along with the swelling in her groin.
There were regular calls to the GP practice, often from Elaine’s two daughters who were desperately worried about her, but she was still not offered an appointment – either by telephone, or face-to-face – with a doctor.
In late November, Elaine was seen by a practice nurse, who carried out some blood tests. The results, sent to the practice from the laboratory, recommended she was referred to an oncologist, and the surgery invited her in to discuss them.
By then, Elaine could not stand unaided. Yet reception staff initially refused to let her in the building, insisting face-to-face appointments were for ‘serious cases only’.
Her GP did refer her to a cancer specialist, but insisted it was unlikely to be ‘anything sinister’. He was wrong. During a hospital appointment, Elaine was told she was not only in kidney failure, but seriously ill with rare and highly aggressive Burkitt lymphoma.
Four rounds of chemotherapy later she remains in hospital, her prognosis uncertain.
Lewis was refused an appointment… and lost a kidney
Landscape gardener Lewis Moon, 36, has lost most of the function in one of his kidneys after he was refused a face-to-face appointment to treat a urine infection.
Lewis, from Wilmslow in Cheshire, developed a headache and fever in September and, two days later, started to feel discomfort when going to the bathroom.
The following day, a Sunday, his fever worsened and he began experiencing pain around his right kidney, and concluded that he had a urine infection.
He rang his GP surgery as soon as it opened on Monday morning, and was offered a telephone consultation with a nurse.
‘She was asking me what I thought was wrong,’ he says. ‘I explained how much pain I was in and she agreed it was probably a urinary tract infection and prescribed antibiotics.’
But as the level of pain increased and he started vomiting, Lewis rang the surgery twice more but was still refused an appointment with a doctor. After phone calls with a nurse, he was offered liquid painkillers and antibiotics which would be easier to keep down. Lewis says: ‘By 4am the following day, after 12 hours of not keeping even fluids down and nearly 48 hours after first contacting the GP, my girlfriend Rebecka drove me straight to A&E, where I was put on a drip and spent the next five days on a ward.’
Specialists told Lewis the level of C-reactive protein in his body – a sign of inflammation or infection – was above 550mg/litre. A normal result is 10mg/litre, meaning that Lewis was fighting a severe infection.
He has since seen a renal specialist for an imaging scan on his kidneys, which revealed the right organ is now functioning at only ten per cent of its normal level and have suggested removing it.
‘The specialist said the high levels of C-reactive protein had likely caused more damage to the kidney, and that if I’d been seen sooner major damage could have been prevented. If the doctor had seen me, in person, then they’d have realised how ill I was.
‘Although I can live a normal life on one kidney, it could have been avoided. Was I fobbed off because I was young?’
For this type of blood cancer, catching it early is key. The hospital has written to Elaine’s GP surgery to establish why she was not seen sooner – but there has been no reply.
Elaine’s sister-in-law Sarah contacted The Mail on Sunday after reading the ‘horror stories’ from other desperate patients who have struggled to see their family doctors throughout the pandemic.
Although they wanted their story to be told, Sarah asked us to use pseudonyms, for privacy reasons while Elaine remains in hospital. We, of course, agreed to this.
‘People are dying because they’re not able to see their GP,’ Sarah says. ‘We are completely devastated by what has happened to Elaine.
‘What she experienced wasn’t care, it was an absolute lack of it. Worse, it was disinterest.
‘To compound it all, my brother has been refused even telephone appointments despite his records clearly showing he is extremely susceptible to chest infections and may need antibiotics regularly. Twice my nieces have resorted to calling 111, which despatched an ambulance.
‘When one of my nieces finally lost her temper and raised her voice to the practice manager, she was told that her call would be terminated because she wasn’t being “very nice”. My niece pointed out that almost killing their mum and dad was also not very nice.
‘The distress and despair caused to our family has been shocking and, it seems, is being repeated for patients and their families across the country.’
Sarah is right – at least, if the 1,000-plus letters to The Mail on Sunday are anything to go by.
Since November, when we began writing about the problems patients have experienced trying to contact their GP during the pandemic, they have been piling up. And the latest batch, over the past month alone, are the most distressing yet.
A significant number describe going to A&E after being unable to even get through to their GP on the phone. Some were hospitalised with conditions which, had they been caught earlier, could have been easily treated at home. Others, heartbreakingly, have endured the death of a partner.
Eric Jones, 76, lost his beloved wife, Joyce, 75, last August to lobar pneumonia, which developed into deadly sepsis.
Her condition was misdiagnosed as a simple chest infection during a telephone consultation with her GP. Eric tells the story in the panel on the right.
That surgery doors remain largely closed is becoming increasingly incomprehensible. Over the past week, new Covid infections have fallen to an average of 2,000 a day, and deaths to single figures.
Scotland recorded a week with no deaths at all.
In a week’s time, pub-goers will be able to enjoy an indoor pint and the Government has published a ‘green list’ for countries we can travel to and from without restriction.
But the guidance on how surgeries should operate during the pandemic, introduced by NHS England, remain firmly in place – and today, The Mail on Sunday launches a new campaign to demand a shift in thinking.
While digital and remote services have offered convenience to some, they have caused much misery to many others.
And so we are demanding that NHS England changes its guidance so all GPs must prioritise seeing patients face-to-face again – and that they are given enough resources and support to do so.
‘Fobbed off’: Lewis Moon, from Wilmslow in Cheshire, pictured above with his girlfriend Rebecka, was only offered a telephone appointment with a nurse
GP leaders point to the fact that the proportion of appointments being held face-to-face is recovering. That’s true: NHS Digital figures show the number of patients being seen in person in March had doubled to 15 million, compared with the first wave peak in April last year.
That represents about 55 per cent of all appointments, still significantly down on the 80 to 85 per cent face-to-face consultations before the pandemic.
But a closer look at the figures reveals that only about a third of these were actually with GPs – the remainder were with nurses and other healthcare staff. Before Covid, the majority of in-person appointments were with GPs.
This situation is unlikely to get much better. In fact, the Government wants these changes to be permanent. An NHS England paper published in March says that even more appointments should be online in future.
IT’S A FACT
The average GP surgery today has about 8,500 patients on its books – up from roughly 6,000 15 years ago.
This is about adopting what it calls ‘total triage’.
This policy is what’s happening now – patients explain why they want to be seen by completing an online form or speaking to a receptionist, and staff will then decide whether they need a telephone appointment with a nurse, GP or other healthcare worker, or whether they should be seen in person.
This was always on the cards even before the pandemic, but some say Covid has provided the perfect excuse to speed up its delivery.
A reader from Essex, who asked not to be named, said: ‘I’m all for some sort of triage but we must be allowed to actually physically consult with our GPs again. My biggest worry throughout this pandemic has not been catching the virus but that things, in every walk of life, would never go back to the way they were, and it seems that is going to be the case.’
Two readers contacted us to say their GP practices, both in Kent, had already announced they would be ‘digital first’ permanently – which means all appointments will have to be booked online.
This was described in patient leaflets as an ‘upgraded service’ which meant patients would no longer ‘wait in a phone queue to speak to the surgery as patients can quickly and easily make contact online’.
Such measures are designed to ease problems that existed long before the pandemic. Over the past decade, hundreds of practices have closed or been merged despite a growing population, while many GPs are leaving or retiring early due to burnout or stress, and fewer are being recruited.
The Government guidance on how surgeries should operate during the pandemic, introduced by NHS England, remain firmly in place – and today, The Mail on Sunday launches a new campaign to demand a shift in thinking (file photo)
The pandemic has simply exacerbated those issues, according to senior doctors, while the vaccination programme has added additional pressure to an unprecedented workload.
According to Dr Alison George, a GP who chose to begin working in A&E last year after her practice elected to continue with remote appointments, the current model is ‘failing patients’ and ‘like practising medicine blindfolded’.
‘This is a catastrophe waiting to happen,’ she says.
‘Remote consulting definitely has a place in modern primary care, but it is not in the best interests of patients or GPs. I’ve had patients coming in to A&E, delirious with sepsis, who would have been given a mental health referral over the phone. They would have died overnight had they not come in.
GP diagnosed my wife by phone with chest infection… but it was sepsis
Eric Jones lost his beloved wife Joyce in August when a bout of pneumonia swiftly developed into fatal sepsis.
The grandparents, from Wilmslow, had been married for 57 years and had two sons.
Keen gardener Joyce, 75, was ‘fit as a flea’, says Eric, 76, and was even looking after him after recently suffered two strokes.
But she began feeling ‘weak and knackered’, and the next day couldn’t get out of bed, so Eric dialled the NHS 111 helpline for advice. The service then contacted his GP, who rang him back the same day.
‘I was trying to describe what was wrong – it was as if her lights had gone out,’ he says. ‘I was emotional, as this wasn’t like her at all. The GP said it was nothing more than a chest infection and sent round antibiotics. There was no suggestion of a visit.’
But soon Joyce couldn’t walk. In desperation, and unwilling to navigate through to the GP again, Eric rang his physiotherapy clinic, which advised that he dial 999. An ambulance was dispatched which took Joyce to Macclesfield District General Hospital, but she died later that day.
‘I can’t prove that if the GP had seen her in person it would have changed the outcome,’ Eric says. ‘But part of me believes that if they’d seen how ill she was, she may still be alive today.
‘The nurse on the intensive care unit where Joyce was taken was livid – she couldn’t believe the GP was relying on me to tell them what was wrong.
‘I’m devastated. It’s still so raw. We had a lifetime together.’
‘I’ve spotted melanoma skin cancers in patients who’ve come in for other problems, and Parkinson’s in a patient just because of the way she walked into the consulting room, but the digital model removes the option of opportunistic or preventative healthcare. It treats a symptom, not the patient.
‘This is a cheap way of dealing with the problems in GP recruitment and it’s outrageous. Of course, those who support it say GPs do still have the option of seeing patients in person, but we know from the current situation that this is simply not happening in some cases.
‘All GPs need to be seeing patients in person or we risk a disaster in primary care – I’m already seeing the results of it in A&E.’
There is also evidence the shift to online is, paradoxically, increasing that workload even further – by making GPs easier to access.
Some practices in Kent have even been turning off their online forms in the evenings and at weekends because they have been ‘inundated’ with demands.
This is backed by a study by Chris Salisbury, a professor of primary care at the University of Bristol, which found ‘digital first’ access, using online consultation forms, drove GPs’ workload up by 25 per cent because many patients needed to be seen again in person.
One GP practice even wrote a letter to its patients last week, essentially blaming them for a flood of enquiries which overwhelmed its service.
Ivy Grove Surgery, in Ripley, Derbyshire, said patients weren’t doing enough to look after themselves and were presenting them with ‘a shopping list of multiple problems’. ‘We are quite sure that you would not see your solicitor in a single appointment slot (however long might be allocated) and present them, without warning, with an employment contract issue, a divorce issue and a boundary dispute issue, all of which need resolving by the end of the appointment,’ the letter read. ‘However, as GPs, we are frequently expected to deal with three or four problems within a ten-minute time slot.
‘That is exactly 150 seconds to deal with each problem. Count them. You will all know that this is not humanly possible with the laws of physics being what they currently are.’
Many GPs have applauded the letter’s honesty, but others said it was inappropriate to blame patients for its problems and would add to their misery.
Speaking to The Mail on Sunday’s Medical Minefield podcast last week, the chair of the Royal College of GPs, Professor Martin Marshall, acknowledged that both staff and patients were stressed and unhappy with the current situation. While it is wrong to blame patients for today’s pressures, he said it was also wrong to blame family doctors.
‘There simply aren’t enough GPs to provide the kind of care we used to provide,’ he said. ‘This is a crisis which only policymakers can sort out. And it doesn’t seem fair to be blaming GPs for what is essentially a lack of resources.’
Ominously, he also suggests remote services may become the new normal: ‘General practice is changing. And I think it will take some time for the public to get used to that.’
This will come as no comfort to the scores of readers who write to this newspaper, exhausted and upset by the situation.
Eric Jones lost his beloved wife Joyce (pictured above) in August when a bout of pneumonia swiftly developed into fatal sepsis. A GP diagnosed her over the phone with a chest infection
One 83-year-old, who has been with the same practice for 50 years and lives with asthma, Crohn’s disease and chronic obstructive pulmonary disease (COPD), told us: ‘I am obviously of no interest because of my age, and for the first time in my life I am suffering from depression.’
Another reader, writing about her 96-year-old aunt who has no mobile phone or internet access, said her GP failed to contact her about her Covid vaccine.
‘We have since found out that others who do not have access to modern technology were also missed off the list,’ she wrote. ‘It appears this surgery doesn’t know how to use a landline.’
But even those who can use the technology feel let down. Di Heenan, in Manchester, also ended up on an antibiotic drip in hospital for 24 hours after her GP, during a video call, said her foot infection was ‘just a big blister’. ‘I wasn’t happy – and neither was the A&E doctor,’ wrote Di.
IT’S A FACT
800 UK GP practices have closed in the past eight years, forcing 2.5 million patients to go elsewhere, the doctors’ magazine Pulse reported.
Julie Shepherd in West Sussex said she and her husband managed his diabetes ‘all on our own’ following an operation to remove part of his pancreas just before the pandemic. ‘He has experienced sepsis three times in the past year and we have had to fight continuously to get his prescriptions, battling our way through the surgery’s phone call system and the receptionists,’ Mrs Shepherd said.
‘If it hadn’t been for the fact that I work for the NHS and have contacts at work, my husband would probably be dead.’
She added: ‘We now have no faith at all in getting any help if he is sick again. I don’t bother any more – I just take him to A&E, like I did last time when he had chest pain and breathing difficulties and ended up having a coronary stent inserted.
‘Perhaps if he had his regular check-ups and someone from the surgery had followed him up, this could have been avoided.’
Yet another reader, whose wife had previously been diagnosed with the blood cancer chronic lymphocytic leukaemia, was told to try throat lozenges during a telephone consultation when she complained of breathlessness and problems swallowing.
He chose to have her seen privately – and the consultant immediately admitted her to hospital and diagnosed her with an aggressive non-Hodgkin lymphoma, which had spread to her lungs, and sepsis.
‘I have no doubt whatsoever that, had I not paid privately to see that consultant, my wife wouldn’t be alive today,’ he wrote.
‘The whole practice is an utter disgrace as they have lost sight of why they are there. Their attitude is putting people’s lives at risk – but they couldn’t care less.’
One concerned patient from Kent speaks for everyone. She wrote: ‘It is time, urgently, for NHS England to rectify the situation.’
NHS England was asked about the detailed concerns raised above, but failed to add anything to its previous statements. A spokesman said GP ‘teams’ were offering face-to-face appointments, and added the NHS would ‘continue to regularly review the process for accessing appointments’.
We just needed some reassurance
By Dan Hyde, Mail on Sunday Assistant Editor
I avoid a visit to the doctor’s surgery like the plague, but there are moments in life when nothing else will do.
One of those times sneaked up on me and my wife Katie shortly after the birth of our first child, Freddy, seven weeks ago.
He was bothered by some symptoms that had lingered since he was born, and an evening Googling only dredged up a heap of nonsense that left us none the wiser.
Dan Hyde, above, with his wife Katie and first child, Freddy, who was born seven weeks ago
So the next day we called our GP and asked if we could pop in – we wanted reassurance from a professional who could poke and prod Freddy and tell us everything was going to be all right. Any new parent will remember those terrifying days when, sleep-deprived like never before, you worry that every cough or cry is a sign you’re getting it dangerously wrong.
Yet the receptionist at our usually faultless GP surgery could barely have been less accommodating. No, we couldn’t see the GP – they would phone us later that day.
When the GP called, he said he couldn’t give us definitive advice without seeing Freddy, and so he booked us an urgent appointment for that evening… at another surgery. This only made us more anxious.
The doctor who saw us had no notes on Freddy, nor even any information on why we were there. Thankfully, it took her no more than ten minutes to decide there was nothing wrong with him. More importantly, we were sent home with the comforting words that can only ever be delivered face-to-face.
Quite why our own GP couldn’t have done the same, I have no idea – and neither did the marvellous doctor we did see.
What’s really causing this crisis? We grill Britain’s chief GP on MEDICAL MINEFIELD
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