Long waits for appointments have become the norm (Picture: CMRF Crumlin)

 
 
Why is it so hard to get an appointment with a doctor?
 
Part of the answer is about increasing demand. Each full time GP in England is now responsible for an average of 2,295 patients, that’s an increase of almost 20 percent since 2015.
 
That’s combined with the fact that our patients are getting older and have more complex health needs. That means they need to be seen more often, and for longer.
 
Added to that is the collapse of other types of care—including drop-in centres for people with specific conditions, dedicated phone lines, and the effect of the huge waiting lists for hospital treatment.
 
The second part of the answer is about the shortage of doctors. Older GPs are leaving the job and retiring earlier, and younger, junior doctors are put off from GP training because they know how hard the job has become. 
 
There are also some additional problems with appointments. Some GP practices have changed their booking system so that most of it is now online.
 
That can leave out people that don’t have access to the internet, or who don’t feel confident about using it.
 
It can also mean that doctors see and treat patients far later than they’d like.
 
Another problem is that my practice has, since Covid, moved away from having any walk-in services at all. 
 
That means people who are sick and without an appointment, but who are willing to wait a long time, no longer have that option.
 
Again, a lot of that is down to low staffing. What’s making doctors want to leave the profession?
 
The job has become incredibly stressful and demoralising, mostly because as a GP you no longer feel as though you can resolve any of your patient’s issues.
 
In fact, you feel utterly helpless most of the time. For example, I often see patients who have chronic lung disease who live in poverty, in cold, damp and poor housing that makes them sick. 
 
But there’s nothing I can do about their living conditions, so I can’t really help them. As a doctor that sense of failure eats away at you. 
 
Can you describe a typical working day? 
 
I start early in the morning by going through all the online appointment’s allocated to me.
 
I assess which ones might be dealt with over the phone, which patients need to come into the surgery, and which ones will need a home visit.
 
After I’ve seen and called my patients, I move on to home visits—each one can take up to an hour.
 
Back at the surgery, all of us have a rotation of tasks, including repeat prescriptions, test results, and dealing with urgent letters. 
 
Even if someone has clear test results, they must be told they are clear. So, you can spend a lot of time phoning people or making follow up appointments.
 
Doctors must also provide support to the reception staff on the front line, and deal with problems they raise.
 
Unfortunately, some patients who are unsatisfied take out their frustration on receptionists. So doctors have to give them back up.
 
At the end of the day, after all that essential work is done, I move on to an array of government forms. These often concern additional services that the NHS pays the surgery to deliver.
 
There are now so many targets affecting our funding that the practice has to take on extra staff just to make sure we hit them. 
 
Some people think that when doctors are not seeing patients, that they aren’t working. That’s simply not true.
 
GP’s recently voted to reject the government’s new contract, can you explain why?
 
We rejected the government’s offer of a 1.9 percent increase in core funding for GP practices because it will harm patients.
 
The below inflation rise will make GP surgeries worse, not better. The contact is not about how much ordinary, salaried doctors are paid. That’s a separate issue.
 
The low funding increase will mean more doctors who are “partners” will resign. Partners are doctors who own and help run the companies set up to run GP practices. 
 
But the job has become almost impossible, leading to a nationwide shortage of partners.
 
That already forces some GP firms to dissolve and hand back their NHS contract.
 
This is exactly what the private healthcare companies circling the health service are hoping for. 
 
Firms, such as the US multinational-owned Centrene, want to run GP surgeries for profit. They do this by employing cheaper staff to do the work of qualified doctors.
 
Among these are physicians associates. They are expected to shoulder responsibility they are not trained for. That’s not fair on them, and its not fair on the patients either.
 
The aim is to use less qualified staff to treat minor illnesses, such as colds, and leave difficult cases to GPs.
 
But that will damage the relationship between doctors and their patients.
 
Often people come to the surgery with a simple problem but really wanting to discuss something else—something more complicated, and potentially more important. 
 
A doctor who knows their patient well may be able read the signs—and a fully qualified one can help diagnose sexually transmitted diseases and cancers, as well as domestic abuse and mental distress.
 
How can GPs fight back against the contract?
 
We must first recognise what is at stake. If we don’t fight then GP surgeries will suffer the same fate as NHS dentistry—private interests will smash everything good about it.
 
After the emphatic vote to reject we must now act. There is a lot of debate about what we should do.
 
I believe we must hold the government’s feet to the fire.
 
Dr Jackie Applebee is a salaried GP and the Unite union rep on the General Practitioners Committee. 
 
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