Health chief says it's a 'myth' GP services will return to normal

A health and adult social care scrutiny board meeting held at Sandwell Council on October 4, discussed ways to alleviate widespread demand for access to GPs amid a “shortage of supply”.

Michelle Carolan, Sandwell managing director for NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG), said: “Regardless of coronavirus, the GP Forward View report back in 2016 said that all GP consultations should start with a telephone triage.

“Although we had coronavirus, that was always the plan. So that’s not going to change. We’re never going to go back to the 1950s model of care that hasn’t changed for however many decades. So how can we get this message across in a positive way?"

Dr Ian Sykes, clinical chair of NHS Sandwell and West Birmingham CCG, said he wanted to dispel the “myths” about the pandemic and GP telephone appointments.

General practice is currently open – and has been throughout the pandemic – but because of coronavirus the way patients are seen in primary care has changed.

He said: “Many people think that, of course, we have come out of the pandemic and things are back to normal. That’s completely untrue.

“The pandemic has not gone away. Hearing the sobering news of a 15-year-old girl Portsmouth die of coronavirus shows that nobody is immune to this.

“You can go out shopping, go on holiday, go out for a meal, and you can go away and spend the night with your friends, so why can’t you see your GP?”

The main reason for this, Dr Sykes argues, is that GP surgeries are not designed for “consensual social distancing”.

He said: “We know that GP surgeries are not designed for consensual social distancing. And the last thing we want is to be bringing people into our surgeries that may have coronavirus, or who have got coronavirus, and subject either our patients, or staff to that infection.

“We’re still having some restrictions in place because we want to make sure it is safe. What we don’t want is at eight o’clock in the morning, 15 or 20 people queuing up outside a surgery, trying to book an appointment or prescription, because if one person has coronavirus, they’re likely to spread it to everyone else.”

In a presentation shown to councillors, 570,000 residents in the Black Country were seen by a GP this year – an increase from August 2019 of 547,000 residents.

According to the same figures, 57 per cent of those people were able to have face-to-face appointments. And 49 per cent of people who requested a same day appointment were seen. The England average for successfully requesting a same day appointment is 41 per cent – an increase of eight per cent. But the number of GPs working in the region is falling.

In 2016, there were 0.52 whole-time equivalent GPs per 1,000 patients. In 2020, there were 0.46 whole-time GPs per 1,000 patients – representing a drop of 16 GPs.

Councillor Yvonne Davies, former leader of Sandwell Council, raised her concerns about people waiting for a lengthy period of time on their phones for an appointment.

She said: “I do think there is a massive problem with phones. And I don’t think looking to the future, to recruit more GPs or mental health providers, will solve it.

“There has to be a way found to free up telephone time, because if we’re saying 45% of people can’t get through on the phone every week, that is thousands of people who are talking to each other, and they’re phoning again and again and again.

“The system is being locked in a vicious circle of not being able to answer the phone, and people phoning at a different time.

“I appreciate you may not have the resources in the GP surgery, but even using a triage system, and perhaps using social prescribers or physical therapists – whoever – to man the phones, not separate to receptionists, may be a solution.”

Councillor Ann Shackleton said: “The number of complaints I get about receptionists, my constituents asking ‘how do I get past the receptionist?’, and are fed up of having to repeat their symptoms to a receptionist.

“A health care professional could probably deal with their concerns, but they need to speak to a doctor to have that referral. So how do we do that?”

Dr Sykes said: “Our receptionists have a really difficult job, and they’ve taken the flack of patients, and we know they are taking a huge amount of verbal abuse, and in some cases physical abuse.

“The ideal system is to have a lot less people need to speak to receptionist in the first place. A lot of people ask ‘why don’t you have more receptionists’, the problem with that is it is only good having more receptionists if you have enough phone lines.

“If you have more telephonists, where do you put them? Then there’s employing them, training them, and can we afford too, because they’ll be busy times and quiet times.”

He added: “Do you actually need to be seen by a health professional in the surgery? Or is it something that can be dealt with better outside? For example there is a minor aliment scheme where pharmacists in Sandwell can provide advice, and can dispense medication to patients on free prescriptions.”