An Open Letter To Our Patients About The Pressures On General Practice
Dear Patients, thank you for bearing with us during these hugely stressful times for everyone. We have strived to provide you with the best service we can.
As many of you may know, General Practice has seen absolutely unprecedented pressures over the last 12 months and this continues to increase. It has genuinely been the most challenging times of our careers.
GPs are currently dealing with more patients than prior to the pandemic, along with all the constraints of covid cases and PPE, whilst also delivering the biggest vaccination campaign the country has ever seen.
Our own demand at High Street surgery has increased significantly in recent months. As the graph below shows, we’ve been busy throughout the pandemic, but it appears to be peaking significantly now. We have seen an increase in consultations to date compared to the year 2019 which was pre-pandemic of 19%
Total Appointments by year:
All GP surgeries around the country are experiencing the same problems. National data shows that GP appointments have increased by 18% compared to March 2020 and 11% compared to March 2019.
We hope that providing our patients with this letter will help you to understand what is happening in General Practice at the moment.
We have been promoting Online services for some time now but still only 38.9% of our 7900 patients are signed up. As we are providing more appointments and ever before this inevitably contributes to heavy telephone traffic and creates problems accessing these appointments in busy periods. Using online services can bypass the phone system giving those that are not online service users easier access to appointments. Our systems are designed to give users of both telephone and online services the same opportunities to access available appointments.
We have never stopped seeing our patients Face to face even during the Covid pandemic. We offer telephone consultations in the first instance as this allows us as a practice to offer more appointments to our patients. The average time allotted to a telephone consultation slot is 5-10 minutes, compared to the average face to face appointment slot which is allocated at 10-15 minutes. If we were to offer all face-to-face appointments that would dramatically reduce the amount of appointments available to our patients.
Our clinicians will carry out the consultation over the telephone and if it is deemed that a face-to-face appointment is warranted this will be arranged, usually the same day.
We find that this method is working well and think this is the most effective way to maximise our patient contact.
Urgency of appointments must be deemed on a clinical (medical) basis, and not based on convenience, prior arrangements or just wanting to see a Clinician that day. Misuse of urgent appointments impacts on our patients who are genuinely vulnerable and in need of urgent care.
We set a safe capacity limit for our urgent triage list, but this is not absolute. When the capacity has been reached, the receptionist will continue to take information from all patients requesting an urgent appointment. They will continue to signpost patients if appropriate, but if the patient feels the problem is urgent then a discussion with a doctor will take place, as we always put patient safety first.
Increased contact for early onset of minor symptoms
Many of our patients are contacting us in the very earliest stages of their condition, seeking GP medical intervention. Often self-care is the most appropriate action – if you are unsure NHS 111, our website and your local pharmacy can help.
We have patients contacting us within a few hours of developing a sore throat, or an earache that developed the night before, or tiredness since waking up that morning or having vomited or having had diarrhoea just the once. People respond to illness differently, but please consider self-care first.
We are not in any way suggesting that if you are seriously ill, or if you have a red flag symptom, that you need to wait to get worse before getting in touch with us. No, not at all. We're talking about people who are still very well in themselves, carrying on with all usual activities, going to work, out to the shops and so on but with very short-lived minor illness symptoms and who have not tried anything at all to help themselves, or waited to see if things improve.
With self-care and due attention, most cases of minor illness do resolve without ever needing treatment from the GP.
Signposting is not about “fobbing patients off” or stopping patients seeing a GP. Signposting is vitally important especially as we are getting busier and busier.
We want to start to overcome the idea of needing to see my GP for every condition. We value our patient care and want to maintain this for complex ongoing patients. We also want to promote best patient care for minor acute conditions via effective signposting.
The aim of signposting is to share good practice and get the correct intervention for our patients more effectively and quickly. For example, our reception team can book first contact physio appointments for back or joint problems. For medication issues we can put you in touch with our Practice Pharmacist. Home visits may be conducted by our Paramedics. We can also help signpost some Mental Health issues and Social issues can be referred to our Social Prescriber.
Multiple problems presented within one Appointment
Since so many people are desperate to see or speak to the GP, we are finding that many people are presenting lists of multiple problems to us; we can best manage these if you tell the receptionist, or note this in your online access triage request, so that enough time is allocated to your needs.
A clinician’s time is limited. Their job involves so much more than just seeing patients. They have their own learning and development to maintain. They are supervising the other clinical staff in the practice and the PCN; they are teaching new doctors; they are involved in leadership; taking action on hospital letters; processing blood results; suggestions from community staff; working with pharmacists, dealing with the availably of medications in the UK and our partner also has all the responsibilities that come with being an employer. We ask that you remain flexible and give our reception team the information they need as it may not be possible to see the doctor of your choice on the day of your appointment.
Aggression and Abuse
We understand that it can be frustrating getting through to us and as we are dealing with 19% more consultations this means we have less capacity to help everyone.
Sadly, there is significant minority of our patients who are aggressive and abusive to our staff. Our staff work hard and are doing their best to accommodate our patients. They do not deserve abuse or aggression form anybody and we have a zero-tolerance policy in place against this. Time spend comforting tearful staff, listening to abusive phone calls and copsing letters to abusive patient s is time that could be better spent looking after our patients.
In the last 12 months we have
- Adapted to huge challenges of the pandemic.
- Kept our patients and staff safe.
- Participated in the largest vaccination programme.
- Delivered record numbers of flu vaccine.
- Offered more appointments than we ever have.
- Recruited new clinical and clerical staff.
- Adapted to the changing practices of the NHS.
Thank you for reading and we hope this information has highlighted some of the pressures general practice is facing. Thank you for your patience and understanding.