GP abuse and services under pressure

GPs and their staff across Lancashire have been subjected to “appalling” abuse by some patients during a recent period of increased demand for services, according to a senior doctor from Chorley.

Dr. Lindsey Dickinson, chair of the Chorley and South Ribble Clinical Commissioning Group (CCG), told a recent meeting of the organisation’s governing body that primary care had a huge volume of “catching up work” to do, including annual reviews that had become overdue overdue because of the pandemic.

She added that the sector was beginning to feel the effects of delays in pre-planned hospital care, meaning people were seeking help while awaiting treatment for outstanding problems.

“Those patients are re-attending GP surgeries…so I think that’s also increasing the ongoing demand that we wouldn’t necessarily have to quite the same level,” explained Dr. Dickinson.

However, it appears that patients are not always proving patient, with the GP recounting “the amount of incidents that we have had, locally and across the county, of abuse of staff – of really quite appalling behaviour by patients at times”.

“These are people who are unwell and may have had difficulties getting through to the practice…but we have seen a significant increase in abuse. And that’s really upsetting, because at the end of the day, primary care is there to do the absolute best it can – and it is inexcusable to have those sorts of behaviours, no matter what the situation,” Dr. Dickinson added.

A separate meeting of Lancashire and South Cumbria’s integrated care system (ICS) board earlier this month heard that “myths” had developed over the availability of GP services since the pandemic struck.

Contrary to public perception, face-to-face appointments had been offered throughout the Covid crisis, members were told. After a slump in overall activity levels during the first and most restrictive of the lockdowns, the number of consultations in some parts of Lancashire was 25 percent higher in April this year compared to the same month in 2019.

Video appointments in Lancashire rose from negligible levels pre-pandemic to more than 2,500 being carried out during March 2021. However, they still comprise less than one percent of all non-face-to-face work, with telephone consultations being used far more widely – and more than quadrupling in number across Lancashire and South Cumbria between February 2020 and this March.

However, in-person consultations have also risen again as the pandemic has progressed, accounting for 55 percent of all GP activity in the region by the start of spring this year. Nevertheless, around 125,000 fewer face-to-face appointments were carried out across the patch in March 2021 compared to February 2020 – a fall of just over 20 percent.

But Fylde coast GP Dr. Amanda Doyle, who is chief officer of the ICS, said that speaking to a doctor over the phone was “not a negative thing for lots of patients”.

“You can solve the problem and sort out what the patient requires – they will be confident they will be phoned back and can go to work and don’t have to stay at home…or go down to the surgery.

“This is something lots of practices have done for a long time, which lots of patients really value – we have just got to remember that it’s additional to face-to-face consultations, where people really need them, not instead of.

“One of the biggest stresses for practices over recent weeks has been dealing with the increasing demand and the challenge in an environment of feeling that…they’re being blamed, as it were, for not being able to provide everything that everybody wants.

“This is not about practices shutting up shop,” said Dr, Doyle, adding that the issues facing primary care were “complex”.

Acute and urgent primary care services – such as walk-in and out-of-hours facilities – have also now been fully restored in the region, the meeting was told.

Board members heard that ongoing attempts to clear backlogs in pre-planned hospital procedures could ultimately increase pressure on primary care, because of the need for follow-up assessments. There was also a warning that if, as hoped, the vaccine rollout results in fewer people needing hospital treatment for Covid, they could instead be driven to the door of their family doctor.

“People will still be symptomatic – and will still need advice and guidance when they become symptomatic,” explained Dr. Peter Gregory, a GP and chair of West Lancashire CCG.

He added that the primary care sector had also been governed by infection prevention standards that had been set at a national level during the pandemic.

And there was an appeal for public understanding of the ongoing challenges for GP surgeries, which have delivered more than three in five Covid jabs across Lancashire and South Cumbria, totalling over one million doses.

“General practice has always walked that tightrope between patient expectations and demands, versus what is clinically needed – and whilst we have always managed that, both variables have massively changed in the last 12 months,” said Dr. Gregory.

He added: “The public pressure and expectations just…squeezes that pressure a little bit more – so the hope is for people to…just allow us to work through this and get the experience right for patients.”

Lancashire GP appointments pre and post-pandemic

570,678 – number of face-to-face appointments (February 2020)

446,467 – number of face-to-face appointments (March 2021), 55 percent of all GP consultations

0 – video consultations (February 2020)

2,650 – video consultations (March 2021)

78,512 – telephone consultations (February 2020)

359,704 – telephone consultations (March 2021)

Source: Lancashire and South Cumbria integrated care system (data covers both parts of the region)