Patients and GPs share stress and frustration as surgery staff take the strain

The patients:

Ask anyone how they feel about GP services and they are likely to have a story to tell.

People continue to have huge respect for GPs and the work they do, but there is widespread frustration at difficulties in accessing appointments.

Today’s Express & Star survey reflects the unhappiness of many.

Two thirds say they have been forced to call NHS 111 or travel to a walk-in centre because they have not been able to see their doctor. More than 90 per cent report difficulties in getting through to their surgery on the phone. And more than seven in 10 patients say they would rather see a GP face-to-face.

There is also an overwhelming anxiety that GP services will not improve. A total of 93 per cent say they fear it will become even more difficult to see a GP in future.

Only five per cent say they believe GP services have improved in the last 10 years.

People in the centre of Wolverhampton said they understood the pressures GPs were under. But many had stories of the difficulties they and their loved ones have faced.

Kerry Banks, 41, of Bilston, said her mother Christine, died in April. Kerry said she had sought treatment from her doctor in February.

A 59-year-old care assistant, she suffered from chronic obstructive pulmonary disease and had a swollen stomach.

“From diagnosis to death was just three weeks,” said Kerry. “She could not get a face-to-face appointment at the doctors.

“She was given painkillers on prescription. The doctor gave her antibiotics instead of seeing her. She went to the emergency doctors and was told she faced a six-week wait for a scan on her stomach.

“She got taken into hospital by ambulance and she was diagnosed with lung cancer which spread to her throat and kidney which is why her stomach was swelling.

“I do wonder if a doctor had seen her sooner whether her life could have been prolonged."

Kerry’s mother never got to see her GP.

She added: “I don’t have much confidence in the NHS now. My daughter is 22 and suffers with anxiety – but she can’t get a face-to face-appointment.”

Carole Waterfield, 76, of Penn in Wolverhampton said she had not had any face-to-face contact with a GP during the pandemic but her husband Bill, 80, had managed to see a doctor after repeated calls.

“I live near the Manor Road surgery,” said Bill.

“I used to walk down there to get an appointment. They won’t let you in so you have to phone and there is a queue of people in front of you. I did eventually get through and it was about two weeks afterwards that they gave me an appointment on the phone.”

Carole added: “You tend to think ‘I can’t be bothered’ and let it slide.

“It’s an age thing – it’s another ache and pain – and then after a few weeks you have another go.”

She says the situation is worse than before the pandemic and her friends feel the same.

“They are all fed up,” said Carole. “I don’t think the service will revert back – I think it suits the doctors to use telephone appointments.”

Sharon Volter, 30, from Willenhall said she was feeling unwell in June and sought medical help. She said she understood the difficulties facing GPs.

“It was not life or death,” said Sharon, who was living in central Birmingham at the time.

"I could not get through to the doctors’ office and it took two hours to get a reply from the 111 service.

“I understand that in the middle of the pandemic they need to prioritise as they are dealing with a high number of cases.

“After two hours they gave me good advice.

"If it was the fire service or police I needed I would expect them straight away, but for a GP I would expect to wait especially with the pandemic.

"I know other people want it done immediately but it is not an emergency service."

Karen Collins, 67, from Tettenhall sees a doctor at Newbridge Surgery on Tettenhall Road.

Last week she phoned the surgery on Tuesday and was given a telephone appointment for Friday.

Karen said she would then ask for an appointment to see her doctor in person and expects that will be sometime this week.

"It is non-urgent so I am happy to wait," she said.

"I would be more concerned if I had a child. For certain ailments you need to be sitting in front of the doctor.

"Doctors can't see arthritis in the legs over the phone.

"I have no problem at all with my doctor but I know other people have had trouble."

The GPs:

Longstanding chairman of Stafford and Surrounds Clinical Commissioning Group which runs surgery services, Dr Paddy Hannigan has served as a GP in the town for 32 years.

He said that the Express & Star survey was probably “a fair reflection” of the situation, but the findings of the NHS National Patient Survey carried out by market research service Ipsos MORI which implied slightly better responses should also be taken into account to get a clearer picture.

Dr Hannigan said: “There are three particular issues, the diminishing number of GPs in the country. Since 2016 there has been a reduction of 1,900. The government did say it was going to recruit 5,000 which has not happened. The consequences of that are fairly clear.

“Secondly, the national response has been to recruit wider health professionals including nurse practitioners, physiotherapists, pharmacists and mental health workers. We always have patients wanting to see their GP. In order for that to work properly patients need to talk to receptionists to tell them what the problem is, which we call signposting.

“No one is explaining that to patients. The issue here is the language being used. We haven’t got that right. People think receptionists are trying to blocking access, but they need to know what’s the matter so that they can signpost patients to the best person.

“This was in place well before Covid.

“The third strand is about post-Covid. We have had to work differently at the height of the pandemic. We increasingly did that using some video and telephone calls. We are gradually working towards more face to face,” Dr Hannigan explained.

He said prior to the pandemic in-person appointments stood at 80-85 per cent. At its height the figure was about 30 per cent and has since risen to 60 per cent. He said that practices were now working out the right ratios of face to face and phone appointments for their own surgeries.

“The telephone is useful for dealing with quick problems which can be done without people leaving home. Some things have to be done face to face, for example when someone is complaining of abdominal and chest pain. I’m not going to ask them to do it over the phone.”

He also said many elderly patients were comfortable accessing health services online as much as younger generations, but that there were issues with deprivation, social or cultural inequalities which may be preventing some patients from accessing treatment earlier.

The UK is currently ranked 23rd in the world for the number of doctors per capita and 19th for the number of nurses.

Principal GP at Croft Surgery, in Willenhall, and Stroud Practice, in Bentley, Dr Sukhpal Gill is among those in Walsall which maintained a face to face service throughout the coronavirus crisis.

Dr Gill, also Black Country CCG board member, said: “That there is widespread feeling out there that it is difficult to get GP appointments is not to be disputed. The number of GPs has gone down while patient numbers are going up.

“Just before the pandemic struck GPs in England were dealing with 25 million appointments per week. In July there were 28m appointments which is a 12 per cent rise. Day by day we are feeling that the demand has skyrocketed.

“The pandemic has left people feeling anxious, people have been self-isolating and that’s brought on issues for many. We have run the “Help Us, Help You” campaigns to raise awareness of things like cancer symptoms as we know the detection figures were low and that has been just one in a multitude of problems.

“Services are getting back to some semblance of normality. However, we are seeing a lot of work coming back to us from the hospitals, such as certain investigations and prescriptions, which are outside our competence.

“Lately we have been picking up two or three complications per day to expedite with referrals to hospital.The public actually only sees the front-facing work, such as appointments, but a lot of other work goes on behind the scenes.”

Dr Gill added that he thought GPs were being unfairly blamed.

“If it was such a wonderful job then we wouldn’t have had a 1.3 per cent decline in GPs. The government needs to take a serious approach,” he added.

“ I thrive on my relationship with my patients. I see them from cradle to grave. At the end of the day we will be there for them.

“But we do feel vilified especially when we see that horrendous situation in Manchester with staff from a surgery being assaulted. We are worried for our safety.”

Meanwhile, new data has shown that thousands more GP appointments are available in the Black Country and West Birmingham now than before the Covid pandemic.

The latest figures for GP access show that 570,191 appointments were booked during August this year – up from 547,384 in August 2019. Of these, 57 per cent were carried out face-to-face and 49 per cent took place on the same day they were requested.

The additional appointments are the result of an increase in digital consultations, which is part of the NHS’s long-term strategy for primary care but was accelerated during the pandemic so GPs and their clinical teams could continue to see patients safely.

Dr Salma Reehana, a local GP and chair of Black Country and West Birmingham Clinical Commissioning Group, said that staff “are working harder than ever” and are “seeing more patients than ever” – but the demand on services is the “highest we have ever seen”.

She said: “It is pleasing to see that new ways of working have enabled our GPs to offer more appointments than ever before, with a record number of same-day appointments – but we know this is not the picture of general practice that many of our patients are seeing right now.

“We know a lot of people are really struggling to get a GP appointment and we understand how frustrating and upsetting this is. The reality is that even though our staff are working harder than ever, and the statistics show they are seeing more patients than ever, the demand on our services is the highest we have ever seen.

“At my practice, for example, we have seen a significant increase in calls – including a 165 per cent year-on-year increase in June – but due to workforce constraints and other key programmes such as delivering vaccinations, the service’s limited resources have not been able to fully respond to this increase in demand. This means some of those requesting an appointment can’t be seen in the timescale or format that they, or we, would like.

“The CCG and local GPs are working hard to minimise the impact of these pressures, including making use of the wide range of expert clinical roles within primary care – such as pharmacists and physiotherapists – to get people seen quicker if their condition doesn’t necessarily require a GP.”