Doctors feel the pain

In today’s papers (February 26) we read about a single GP in Shropshire who is covering night-time home visits for a population of half a million – a workload that was shared by eight GPs ten years ago, according to new reports.

In an example that illustrates the extent of GP shortages hitting areas across the UK, the lack of out-of-hours cover in Shropshire has reportedly in some instances left cancer patients in pain without anyone to administer morphine.

The Daily Mail has reported that some patients have been told to drive over an hour to see a doctor in Wales, with one woman with a sick child saying she was offered a consultation an 80-mile drive away from her home in Ludlow.

Freedom of Information (FoI) requests from the Mail found that out-of-hours provision is sporadic in certain areas, such as in Milton Keynes, where there is one GP overnight for 290,000 patients; in Cornwall, where there are 3 GPs for 575,000 patients and in Oldham where there is one covering 230,000 patients.

Concerned Doctor’s in Unite (DiU) chair and GP Jackie Applebee said that reports of areas struggling to provide out-of-hours GP cover were not surprising considering the simple maths. “The number of GPs is falling while the population is rising so there is reduced capacity to do all of the things that a GP is expected to do,” she explained.

But Applebee also emphasised that some of the Mail’s claims may in fact be misleading. She believes there is no clear distinction in its reporting made between out-of-hours urgent GP care, which is when a patient cannot wait until the next day, and extended hours, with planned GP appointments offered outside of core hours between for example 9am and 6.30pm.

What’s more, out-of-hours General Practice “does not always require a home visit, though some things, such as palliative care, obviously do,” she said.

“It is entirely reasonable to ask other people to come to a centre and it is a more efficient use of the GP’s time – the GP can see more patients if not having to factor in travelling time.”

Applebee went on to say that linking a rise in A&E attendances to lack of GP appointments, as the Mail has, is inaccurate – the myth was most recently debunked in a large landmark study conducted last year.

The Mail reported that areas that have struggled to fill out-of-hours GP shifts have experienced difficulty simply because GPs are unwilling to work outside core hours, but Applebee told UNITElive nothing could be further from the truth.

“Ultimately, if there are not enough GPs to do the necessary work, some parts of the system are bound to suffer,” she said. “If a GP has already done a 12-hour shift in their surgery they will not then want to be available overnight and nor should they be as it wouldn’t be safe for patients.”

Burnout

GPs are already among the most likely to experience burnout and work-related stress, according to recent research.

This has been linked, a Society of Occupational Medicine report noted, to “the increased demands placed on primary care along with diminishing financial and staffing resources”.

Whatever way you look at it, patients are suffering and GPs are finding coping with ever increasing demands tough. Applebee said that ultimately, “the government needs to fund the NHS properly and make it a place where people want to work, not a place where people feel that they are firefighting all the time and don’t have the adequate time and resources to do their job properly.

“NHS funding has historically increased by 4 per cent a year since 1948, however since 2010 and the imposition of austerity, NHS funding has only increased by 1 per cent a year,” she added.

“This is not enough to keep pace with inflation let alone the rise in population numbers and development of technology. Recent reports have also shown that the NHS is the most productive institution in the country – there simply isn’t any more room for efficiency savings.”