GPs are very demoralised. Their efforts are constantly demeaned
In this article, Derry GP, Dr Paul Molloy, says many doctors and their staff are feeling disheartened as a result of repeated criticism from some people about access to GPs during the Covid-19 pandemic.
Despite the apparent easing of Covid rules, they have not changed for us in general practice. We still have to employ strict infection control policies and social distancing.
Any adult or child with a cough, cold or temperature who presents to us has to be presumed to have Covid. That is irrespective of whether they have had it before or if they have been vaccinated.
We have also been trying to remind people that, if they have these symptoms, they need to get a test. If they are tested and are negative, then we can see them face to face. People are still failing to get tests when their symptoms start. Therefore, when their conditions worsen and they need to be seen, without a negative test, we cannot see them in the practice. Can I, therefore, ask people to get a test as soon as they have any symptoms suggestive of Covid.
Throughout the pandemic, we have been seeing patients face to face as long as they do not have Covid or Covid-like symptoms. Indeed, even those with Covid are seen, if needed, at the Covid centre which is staffed by GPs (the very same GPs who cannot be in two places at once.) So, for 16 months, we have been splitting ourselves across two different workplaces. As I write this, I am sitting in the Covid centre doing an out of hours shift, awaiting my next patient.
With my colleagues, we have also delivered the vaccinations and continue to do so. We are also already planning the flu season vaccinations and will have to use social distancing when planning them.
Perhaps this gives an indication of the multiplicity of the demands on us.
Social isolation rules have not changed. Perhaps someone would explain how we can see everyone face to face, yet maintain social distancing in our waiting rooms? I went to a shop yesterday and it was approximately 10 times the size of our waiting room, yet only 30 people were allowed in at one time. How, then, could we have normal surgeries with full waiting rooms when we can only allow a small number of people into those waiting rooms?
Patients that are seen must be scheduled carefully to avoid spread of any illness. No one will thank me if they get Covid in my waiting room, particularly if I have asked them to come for a face to face appointment.
Despite our repeated direction, we still have people who come for face to face appointments with symptoms that could be Covid. When making an appointment about their rash or sore shoulder, they have failed to tell us that they have a cough and they’ve, therefore, been given a face to face appointment.
Throughout this period, we have been working closely with our hospital colleagues to reduce their problems. The waiting lists in our hospitals and the work this creates for us because patients inevitably end up back with us when they can’t see a consultant - who are also working very hard but on a huge backlog - features very little on social media and, yet, GPs are a constant topic. In Northern Ireland, we have the worst waiting lists by far in the UK. I actually feel guilty at times asking my patients if they have considered going private as, otherwise, they might be waiting years. These are not wealthy people who can afford it. Covid obviously had a detrimental effect on normal hospital services also. They, like us, are employing new ideas like virtual out patient clinics, again to reduce waiting room pressure and avoid unnecessary spread of the virus.
The GP population is demoralised and, frankly, spread very thin. Chronic recruitment issues throughout the west have left us with large list sizes. My GP colleagues are very, very upset with the constant demeaning of their efforts. We are working in practices, in Covid centres and delivering vaccines. In normal times, we would only be doing the former. I’d go as far as to say it is affecting their mental strength. It is easy to forget that we’d prefer to be working as we were 16 months ago. It was much easier only working in one place and not having to worry about wearing protective equipment and making sure people socially distance in the waiting room.
Phone triage is not a new thing; there are patients who do not need to see a doctor face to face. My own opinion, however, would always be that they should be able to, if they want. We would be very hopeful that, when social distancing and Covid regulations are a thing of the past, a system that patients want would be instituted. It might be worth mentioning that a reasonable percentage of people actually prefer the phone system. In my own practice, I would actually acknowledge that, by previously only offering face to face appointments, a group of people - usually young and working during our normal day - were disadvantaged.There are also the issues of chronic recruitment difficulties in the west. We are well short of the number of GPs we actually need and, even with increased training numbers and a new medical school, it will be 10 years before that changes. Many practices in Derry had already adopted a phone first model pre-Covid as they could not meet the demand due to doctors retiring and not being replaced along with people generally getting older and requiring more care. Over the past few years, many of our practices in Derry have been just about coping. They have had to close their lists, due to GPs being sick or retiring and unable to be replaced. They have battled on heroically at times, with extreme difficulties largely unknown to their patients.
It is a fallacy that we ever stopped seeing patients face to face. We still do. We are just working differently at present. I find it funny when a patient, sitting in front of me, asks: “When are you going back to seeing patients, Dr?” I think it sums up this issue.
Can I finally just thank our GP staff and receptionists who have reported increased levels of verbal abuse over the last few months. It’s a very stressful job for them at present.
○ Dr Paul Molloy is a GP based in Derry. He is also secretary of the Western Local Medical Committee (LMC).