“Let them eat cake”, said Marie Antoinette prior to the French Revolution – revealing how out of touch the Queen was from her people. Once widely reported, it contributed to the uprising and her eventual demise. However, she never said it. It is one of history’s earliest examples of propaganda. A statement so powerful that many of us still believe now.
“Your GP surgery is closed” has become the propaganda of the pandemic. According to many journalists, GPs are work-shy, greedy capitalists, who should be paid less so they can’t work part-time.
These persistent distortions have filtered down to our patients. Most GPs have been asked, “when are you re-opening?” by patients actively being examined, in an open GP surgery.
More worrying are those that have stayed away. Women with long-standing breast lumps who didn’t seek timely help because “you were closed”. Coughing children with chronic lung conditions, whose parents thought they couldn’t be seen until their child’s Covid test was back, and the lady with a heart attack, who sat at home for three weeks with chest pain but “didn’t want to bother anyone”. The consequences of this false narrative are deadly serious.
Undoubtedly, there are problems accessing care – but not for the reasons plastered across the tabloids. We have an acute shortage of GPs, fewer than in 2015 and less than a sixth – per head of the population than in compatible European nations. UK GPs are routinely working 10 to 12 hour days.
Fast, good and cheap. You can have only two when it comes to primary care.
Pre-pandemic we were managing cheap. 90 per cent of interactions provided for 8 per cent of the budget. Good? It seemed so, but we were certainly not fast, with on average, a two week wait to see a GP.
When covid hit and we switched to remote consulting, we found something remarkable. We could work efficiently and discovered many primary care issues could be handled remotely, providing a convenient service for our working age patients in particular. For those with complex needs, or those whom an examination was vital, we worked hard to provide face-to-face appointments.
Despite our efforts, there has been a strong press narrative that our practices have been closed to patients and that GPs have been hiding away. Primary care delivered 75 per cent of Covid vaccines and performs over 30 million appointments each month – but we’ve been branded lazy.
GPs are paid on a contract per patient, per year, at around £130 which remains the same if you never visit your GP or if you go every week. This is similar to the cost of one private GP appointment and half the cost of one hospital out-patient appointment.
When demand goes up – like now – there’s no more money to fund this. The only way is to work harder. And work as we might, it is still not enough.
GPs are burning out. Dealing with the fallout from the pandemic, 12 hour days and rising levels of abuse is exhausting.
The Practitioner Health Programme, a service providing mental health support to doctors, reports more GPs referred themselves in the last year as in the total nine years previously. Rates of sickness, retirement and resignation are colossal.
Berating GPs about problems accessing care is in the interests of those who would benefit from private takeover – which would not benefit patients or GPs in the long-term.
Without adequate resources, frontline GPs can do very little to remedy these problems. We need a proper investigation into the problem, as suggested by Healthwatch, alongside serious conversations about funding and what we are willing to pay. We need more funding and better working conditions to promote staff retention. Fast, good and cheap. Which two would you like?
If we don’t address these problems, the line “GP was closed and never re-opened after the pandemic” may be the propaganda my great-great grandchildren will be reading about in history.
Dr Lizzie Toberty and Dr Ellen Welch are GPs and members of the Doctors’ Association U.K.