An open letter to the Patients of Barlow Medical Centre

An open letter to the Patients of Barlow Medical Centre

Dear all,

In the face of unhelpful and misguided media stories resulting in an astonishingly out-of-touch announcement from NHS England, we have felt the need to communicate properly, and as fully as possible, the reasons why Barlow Medical Centre will be continuing with its current model of triaging all appointments in advance, rather than risking the safety and wellbeing of our patients and staff alike.

What’s the problem?

We need to be very clear on this… we have continued to see patients in person throughout the pandemic whenever this has been clinically necessary. But as with all other NHS services, the number of face-to-face appointments has understandably had to reduce to protect patients – particularly those at higher risk if exposed to this potentially lethal virus – and to protect our staff.

Even as restrictions ease, COVID-19 is still circulating and new variants remain a serious concern. To continue protecting patients, we have to limit how many can be in the surgery at any one time – something even NHS England note in its guidance. Social distancing must continue and this means that our surgery waiting room, which previously had space for 40 patients or more, can now hold only eight. We simply cannot go back to the days of waiting rooms full of ill people, and this has a huge impact on the number of patients that can be physically seen each day.

Anything else?

There is much more to it than just this though. Practices in England are dealing with more than 1 million patients’ problems every day at present. At Barlow Medical Centre, where we have approximately 17,500 registered patients, the GPs are consistently seeing or speaking to more than 200 patients every single day. This is just the workload that comes to the GPs – it does not take into account all the patients contacting reception for other reasons, or those seeing or speaking to our healthcare professionals such as practice nurses, clinical pharmacists, HCAs etc.

There is a huge backlog of care caused by the pandemic, and this is really taking its toll on practices up and down the country. Add to this the workload of organising and staffing the COVID-19 vaccination programme, and the fact that we have nowhere near enough GPs and practice nurses, then it is not surprising that those that we do have are completely exhausted

Are other practices in the same boat?

The NHS is currently experiencing some of the most severe pressures in its 70-year history. GP surgeries across the country are experiencing the significant and growing strain of rapidly rising demand, with practices struggling to recruit staff due to chronic shortages.

Alongside these long-term trends, in recent months GP practices have been at the forefront of the NHS’s response to the COVID-19 outbreak. In fact nationally, GP-led vaccination clinics have provided more than 75% of all COVID-19 vaccinations given, with our own service at Chancellors Hotel in Fallowfield playing a significant part in this.

Our GPs at Barlow are routinely working 12-hour days, so it is heart-breaking and demoralising to hear accusations that general practice is not open and that patients are not being seen.

The medical workforce trend shows that doctors are moving towards different working patterns to avoid stress, ill-health and burnout. This means there are fewer of them available to work. A recent survey of doctors by the BMA revealed:

  • almost 50% said they are currently suffering from depression, anxiety, stress, burnout, emotional distress or another mental health condition
  • just under 60% say their level of exhaustion or fatigue is ‘higher than normal’, whilst over 40% said non-COVID patient demand ‘is now considerably higher than pre-pandemic’
  • almost 30% have undertaken additional unpaid hours, whilst over 40% have felt ‘slight’ or ‘significant’ pressure to work additional hours from their employer.

Yet despite all this, practices are still delivering record numbers of appointments

Demand on GP practices has been estimated to be more than 157% beyond capacity. Practices in England delivered almost 5 million more appointments in March 2021 than they did the month before, and nearly 3 million more than they did in March 2019, long before the onset of the pandemic. Same or next day appointments are up by 25%. These are the highest numbers of appointments since records began. Bear in mind also that this data is from 2 months ago, and the workload at least at Barlow Medical Centre has been significantly higher still in the last few weeks. It’s also important to state that this data does not include the huge workload of the vaccine programme undertaken by practices, nor a vast amount of other daily tasks.

And these are increasingly difficult and complex appointments too. This GP explains why quite nicely:

Didn’t the government promise to deliver more GPs?

They did, but it hasn’t happened. A promise in 2015 of 5,000 extra family doctors within five years has actually delivered a loss of almost 1,500 – individual doctors and other practice clinicians are taking on more and more, often outside their paid hours, as demand rises and the workforce diminishes.

The number of patients per practice in England is 22% higher than it was in 2015, but the GP workforce has not grown with this demand. At Barlow Medical Centre we have grown from a list size of approximately 12,000 patients to nearly 17,500 in the last 10 years. Although we have expanded our workforce hugely in that time, there simply aren’t the required number of staff or funding available (more on this below) to adequately satisfy the demand.

As a result of all this, there are now just 0.46 fully qualified GPs per 1000 patients in England – down from 0.52 in 2015. This is significantly fewer than in comparable developed countries.

What about the funding then – can’t you just hire more staff?

OK let’s talk about NHS and GP funding then. The UK spends less of its GDP on healthcare (approx. 9%) than most other developed nations. A study by the King’s Fund in 2018, analysing healthcare spending in 21 countries, revealed “that the UK has fewer doctors and nurses per head of population than almost all the other countries we looked at. Only Poland has fewer of both.” They also state that “the picture that emerges from this analysis is that the NHS is under-resourced compared to other countries and lags a long way behind other high-performing health systems in many key areas of health care resources”

The link to the full study is here for anyone who is interested:

But what about GP funding? Aren’t all GPs “fat cats” like they are portrayed in some media outlets? Well, no. General practice provides more than 90% of patient care within the NHS, but gets only around 7% of its budget. From this “under-resourced” pot of NHS funding, each GP surgery gets less than £3 per week per patient. Not per contact, but per patient. That’s approximately £130 per patient per year, to provide an unlimited number of appointments and contacts, and from this funding we pay our staff and other significant running costs. Before the pandemic patients visited their GP on average 6 times per year, now the number of contacts is much higher.

A hospital A&E department gets about £150 for a single patient visit. One night in a hospital bed costs around £400. We think our colleagues A&E and other hospital departments do a fantastic job with limited resources, but it’s clear that general practice is grossly underfunded and that is a big part of why we are under-staffed and over-worked.

Why are you telling us all this? What can we do about it?

Please be understanding of the situation we are in. We are all working well beyond our paid hours, doing the very best we can and more, to try and continue to provide a safe and effective service. This often means that we have to make decisions based on our patients’ needs rather than their wants.

Please be patient with us and our staff. General practice is open, but our staff need support, patience and understanding as they work harder than ever before. Some patients are understandably frustrated – we get this, we really do – but taking this out on practice staff makes it harder for us to help. The kind and encouraging words that many of you have spoken go a long way to energising us to continue with our efforts.

The waiting times for hospital clinics and operations has gone up significantly. We understand the frustration around this and we really wish there was more that we could do about this but unfortunately we can’t. Please don’t ask us to chase up hospital appointments as we simply don’t have the staff or resources to do this, and it doesn’t make any difference anyway.

Consider writing to your MP about the state of GP workforce, NHS funding generally, and the woefully inadequate proportion of this funding that general practice receives nationwide.

Crucially, practices require understanding, support and resourcing so that they can meet demand and are able to offer patients a choice in the ways they can get the care they need.

In summary

General practice is not perfect. The NHS has been underfunded for years. GP workload has spiralled out of control recently – we are seeing the effects of lockdown on mental health, plus the effects of ever-increasing hospital waiting lists for treatment.

We are truly sorry for anyone that has had a negative healthcare experience recently, but we need your patience and understanding now more than ever.

As the departing NHS chief executive Sir Simon Stevens once said: “If GP services fail, the NHS fails”. If we work together and look out for each other, we can reduce the chances of this happening.

Despite all this the NHS is still one of the best health care systems in the world, and one of the few which are totally free at the point of use. In order to protect our NHS please support it at this very difficult time.

All the best,

The team at Barlow Medical Centre