This is our latest news update following on from our last one in September. Previous updates issued throughout the course of the pandemic can be found here.
In this issue we tackle the increasing levels of negative press and torrents of abuse that GPs are getting from all angles, and also provide some important updates for covid.
As the GP shortage escalates, appointment supply continues to be restricted in many areas of the country.
For many years now, GP leaders have been warning of a building crisis due to the chronic shortage of GPs. As the result, the essential flow of appointments upon which the country depends has been severely disrupted.
GP leaders say that the chronic appointment supply problem has been brought about by the systematic government failure to deliver GPs as promised, failure to invest in training GPs and in GP practices and possibly Brexit and COVID-19 also being to blame.
Panic booking of appointments by a frantic general public, more so since the pandemic, has dramatically increased the appointment shortage. As precious appointment supplies continued to dwindle, the sense of urgency was fuelled by inflammatory comments made by the Prime Minister and the Health Secretary supporting various media outlets, which stated that it was the public's right to book as many GP appointments as possible, preferably face-to-face, whenever they liked, for whatever they liked, whether we were in a global pandemic or not.
Shortly after these statements were made, long queues formed outside GP practices as patients rushed to book last remaining supplies of appointments. Even remote deliveries of appointments were severely affected in some areas, with reports that some patients had to ring many hundreds of times just to obtain one precious appointment.
Staff at some GP practices were facing abuse from angry patients as they finally managed to get through to the front desk only to find the supply of appointments had completely dried up. Scenes of desperation broke out in GP surgery waiting rooms nationwide as some patients were clearly hoarding multiple appointments or topping up with appointments almost every day, leaving little left over for other vulnerable patients who really needed only one to keep them going.
One practice manager reported, "It's completely mad here, never seen anything like it, we have no appointments left at all, and just don't know when we can get more GPs in to drop off some more appointments, given that we already have a couple off sick at the moment and can't get any locums."
One patient, who wished to remain anonymous, said, "It's like a third world country here, we're meant to have this brilliant health service, which we all love, but it seems we just can't get the GPs we need, to deliver us the appointments we want, I mean, we have fewer GPs than most of Europe, what's that about?"
Meanwhile reckless commentary in certain tabloids reported that GPs themselves were obviously to blame for there not being enough GPs, and that such problems could be solved by simply making these fewer GPs work longer hours and for less pay.
In turn, the government has promised swift action, with the Prime Minister indicating that more GPs were on the way, in about 10 years' time when they were all fully trained. The Health Secretary echoed the Prime Minister's comments, stating that the number of GPs promised, about 6,000, would be added up to the previous number of GPs promised, about 5,000, and that this colossal number of GPs would immediately and magically solve the appointment crisis once and for all.
A spokesperson for the Royal College of GPs said, "We have a desperate situation, with fewer and fewer GPs, dealing with more and more patients and working harder than ever before under massively trying circumstances. All we hear from government are hollow promises, which it has made before and which it continues to do so now, quite unashamedly."
The British Medical Association (BMA) said, "Ultimately, the chronic shortage of GPs has been due to the government's single-handed and complete lack of interest and investment in the infrastructure that would allow GPs to deliver much-needed appointments, that would value and support current GPs and that would encourage more doctors to become future GPs."
The BMA continued, "As we don't imagine this attitude changing any time soon, we don't see appointment supply improving now or in the near future and to be honest with you, it's actually easier to get a full tank of petrol than it is to get a GP appointment these days."
DISCLAIMER: To any passing GMC Thought Police, the above is satire
"GPs in crisis" (3:13),
Intelligent Health
The above heartfelt video was made by real GPs and their staff in a bid to provide some balance to the utterly demoralising and distressed messages directed against GPs from a hostile media and government
It seems to be a common and accepted theme in modern society to want to blame someone or something when things go wrong. Additionally, we know that the number of people who make the effort to leave positive feedback is always outnumbered by the number of people leaving negative feedback by around 10 to 1. We know that conflict and criticism sells newspapers, fuels social media, provokes interest and makes money. We know that it is much easier to feed anger, outrage and indignation than it is to stop and acknowledge uncomfortable truths that provoke reflection and induce positive change. All of these feelings appeal to mankind's inherent destructive nature. It seems we just cannot help ourselves. But that doesn't mean that we at Ivy Grove won't try!
So with GP bashing continuing unabated, and with all the 'clap for carers' and 'thank the NHS' being a very distant memory, perhaps it would be an interesting exercise to cast a little perspective and provoke a little rational thought into the current situation. Hopefully the 'story' above started the process.
As an aside, given the single-minded and spiteful nature of the media campaign against GPs, some doctors are guessing that the persistent onslaught from all fronts represents an intentional softening up exercise, promoting a skewed picture of a completely degraded service beyond redemption, requiring major change to be imposed. If this happens, remember you read it here first.
First, some actual facts to set the background. The figures mentioned are all in the public domain and supported by official figures from NHS Digital, the government's own IT arm of the NHS.
So, given what we know above, that we are now even busier than ever before, with fewer GPs, and given that there has been decades of deliberate underinvestment in General Practice, how does it follow that the problems of General Practice are the fault of GPs?
We know there are problems with General Practice, and problems with access, as it is with other parts of the NHS. But is the logical conclusion that the cause of such problems is the fault of GPs?
We maintain that the answer to that question is a firm, unequivocal, definitive NO.
Some logical arguments follow:
DISCLAIMER: Comparisons made between GPs and other parts of the NHS are in no way intended to be interpreted as divisive nor intended to undermine what each sector does - they are provided merely to underline the contradictory and illogical attitude of media and government towards GPs as opposed to other NHS workers who are in exactly the same difficult position
"Inside a GP surgery under 'overwhelming' pressure" (2:37),
BBC News
In the above video, BBC's Panorama team spoke to staff at a surgery in north London, who, like many surgeries, are overwhelmed by demand
The bottom line, which is supported by official figures, is that appointments numbers have increased, whilst GPs numbers have decreased. In not a single one of the negative media articles about GPs, appointments and face-to-face contact will you find this crucial fact. It's far easier to hide behind provocative opinion pieces based on anecdote than to look at the stark facts of what is behind the true crisis in General Practice.
We feel that GPs and their equally dedicated and hardworking staff are being singled out as convenient scapegoats for the genuine problems of the NHS, and with the government and media piling on, we see it as an intentional deflection from the real issues behind these problems, which are caused by a chronic lack of investment against a background of spiralling demand. Rather than tackle these two important issues and make real change, it is far far easier to blame GPs.
Ultimately, as doctors of Ivy Grove Surgery, we came into this job to care for people and to look after them. Every day, our staff come to work to help people. All of us in this practice are doing our very best with what we have to hand. If we had more, we could do more, but as it happens, we can only do our best with what we have.
We know that very many of you do genuinely appreciate what we are doing for you as shown by the spontaneous messages of thanks and the gifts gratefully received. However, we do realise the situation will be very frustrating for others, but we hope that all of you are aware that the current situation is caused by issues that lie several layers above us and unfortunately we have absolutely no control over them.
There is a huge amount of negative press out there bashing GPs left right and centre, spewed out on an almost daily basis. It's extremely easy to find. We're not going to link to it. Instead, we provide some more measured articles that do actually attempt to provide a bit more balanced reporting.
GUARDIAN: GPs are the overlooked crisis in the health service. If we fail, so does the NHS BMJ: Will the NHS survive without GPs? BMJ: Media attacks on GPs threaten the doctor-patient relationship BMJ: GPs are being blamed for government failures in primary care, say doctors Nuffield Trust: Is the number of GPs falling across the UK? BMA: Pressures in general practice NHS DIGITAL: Appointments in General Practice August 2021 UNHERD: The daily horror of being a GP GUARDIAN: Doctors, receptionists and practice teams quit after wave of hostility over GP appointments DR J.G.: What are GPs actually doing? GUARDIAN: GPs are full of kindness and wisdom – so why do they face constant criticism? INEWS: ‘GP crisis is as serious an issue as Covid’: A doctor on why she is furious about the state of her profession STAFFORDSHIRE LIVE: Burton doctors surgery shuts as staff walk out after abuse from patients NOTTINGHAM POST: Nottingham doctor says GPs are 'scapegoats' over appointment frustrations and staff receive daily abuse MIRROR: 'We GPs are stressed, overworked and under fire - we need support before it's too late'
Contrary to the unbending forces of nature, the government and politicians have decided that covid is now over and that we all should carry on as normal. But it's definitely not over. This has lead to the disgraceful statistic that the UK remains in the top dozen or so countries with the highest covid rates in the entire world. The response to the pandemic remains a predominantly political rather than a scientific or medical-based solution.
In other countries, measures are still in place to protect everyone, and especially the vulnerable and elderly. Covid certification, compulsory mask wearing in certain environments and lateral flow and PCR testing, especially for the unvaccinated, has seen other countries cope with rates of covid that are a fraction of the UK's. The narrative in the UK is that we are to live with the virus and carry on as normal.
We all know it's not over. We are still in the midst of a global pandemic that has killed over 4.5 million people so far - this is not including all the collateral deaths from delays to care, missed operations, cancer diagnoses, treatment delays and so on.
In the UK, every single week, the deaths just from covid alone are equivalent of two jumbo jets full of people falling from the sky and no-one bats an eyelid, because it is all hidden away, in hospital wards, in intensive care units, behind closed doors. Sounds awful to say, but if we were to have a major train crash killing 150 people every day then it is quite possible that people would start to notice and want something doing about it.
In surgery, we remain vigilant to the virus and continue to aim to keep everyone safe when they come into contact with the surgery.
As you know, we are copied into the results of covid PCR lab tests that you have performed. On some days 80-90% of swab results returning to us are positive. We are seeing many more children around the ages of pre-school to reception and early secondary years being affected.
We are still having the occasional patient land up in intensive care due to covid. Even if you don't get that ill, there are significant numbers of patients suffering with the unpleasant and prolonged effects of 'long covid' or 'post-covid syndrome', requiring specialist referral and support.
We're still getting many patients with respiratory symptoms who have not booked a lab PCR covid test, thinking that a rapid lateral flow slide test is sufficient, or thinking that a rapid lateral flow slide test is the same as a lab PCR covid test.
Both tests are different, and have different functions. Please see the poster below for info.
Please note that GPs get copies of all lab PCR covid tests performed, so if you state that you have had one done, we can always check the result.
Just a reminder: rapid lateral flow slide tests are NOT to be used if you have symptoms. They are for screening to detect covid when you have no symptoms (one-third of covid patients have no symptoms). If your test is negative then there is a very good chance you are clear of covid infection. If your test is positive, you then need to confirm the result with a lab PCR covid test.
Lab PCR covid tests are used for when you have symptoms. You must self-isolate till you get the result.
GOV.UK: Book a PCR test GOV.UK: Stay at home guidance for covid infection NHS: Poster showing difference between the two tests NHS: What your test result meansWe have previously mentioned that there have been calls for the official UK list of covid symptoms to be updated, just as they have been in other countries. Pressure to update the list continues, however the government has steadfastly held onto the three symptoms of temperature, cough and loss of sense of taste or smell, probably because more tests would indicate more positive results, which would not look too good for official figures.
It is increasingly clear that in many the virus is presenting with cold-like symptoms, so runny nose, headache, sneezing and sore throat are common. Of the official three symptoms of covid, only loss of sense of smell or taste remains in the top five symptoms for those testing positive.
It is thought that people with these newer symptoms, rather than the traditional symptoms of cough or temperature, are going about their business and passing on their covid infection, potentially leading to an extra 20,000 new cases a day.
You might think what the bother is, given this happens with colds every year, and you would be perfectly right if it was just a cold, however, this virus can land you in intensive care, especially if you are unvaccinated or vulnerable.
From a scientific point of view, if the virus is left to spread in the wild, there will be mutations, and then an increased risk of a new variant developing, which would put us all at risk.
If you have symptoms that you think might be due to covid, don't just shrug it off and go about your daily business, please get tested.
GOV.UK: Book a PCR testThere are increasing reports of many patients getting negative lab PCR covid tests after having had positive lateral flow slide tests. As indicated above, if you have a positive lateral flow slide test, you do then need to confirm this with a lab PCR covid test.
As part of the same issue, many patients with definite viral or covid symptoms are also reporting getting several negative lab PCR covid tests, before finally getting a positive one.
There are concerns that the cause might be related to either faulty tests, or a new covid variant that is not being picked up properly.
Public Health England (PHE), recently rebadged as the UK Health Security Agency (UKHSA), said it was aware of the issue and was looking into it after receiving multiple reports accross the country.
Until the issue is fully resolved, we think the key message at the moment is to have a low threshold for covid PCR testing if symptomatic, and to repeat covid PCR testing if it is clinically indicated, that is, if you are still unwell.
We remind any patient and parent that if you or your child is poorly with a viral illness and with a temperature exceeding 38°C, you should not be at work or school in any case, whether the cause is covid or not.
INEWS: Lateral flow tests: Scores more report positive rapid Covid tests followed by negative PCRs as mystery deepens GOV.UK: Book a PCR testAs with all healthcare settings, it remains the case that any patient attending will need to wear a mask. There are in fact very few medical exemptions to wearing a mask, just as there are very few medical exemptions to having covid vaccine.
Your behaviour has a direct affect on your risk of contracting coronavirus infection:
Masks/face coverings are proven to reduce the spread of your respiratory droplets to others.
Face coverings protect others. Vaccines protect you and others. Handwashing protects you and others. Social distancing protects you and others. Ventilation protects you and others. These simple measures will continue to help protect you and others around you who may be vulnerable.
ONS: Coronavirus (COVID-19) Infection Survey technical article: analysis of populations in the UK by risk of testing positive for COVID-19, September 2021On the same day that the Prime Minister urged members of the pubkic to wear masks in crowded spaces, photos surfaced of a packed room full of cabinet ministers and other staff, all without masks.
At a time when coronavirus rates are simply not reducing, and winter illness levels are rising, there may well be a need to employ some simple measures such as social distancing and/or mask wearing.
We therefore urge our patients to follow general common sense and to act appropriately to keep themselves safe, as it is clear that there is no real authority on what needs to be done to keep both people and the country safe in the midst of an ongoing global pandemic.
GOOGLE: Cabinet ministers in crowded room without masksIt remains the fact that those who choose to remain unvaccinated are continuing to put themselves at risk of severe infection, hospital admission and death. A few facts bring this into stark reality:
Pregnancy causes many changes to occur throughout the body. Changes in hormone levels and immune system function can make pregnant women more susceptible to infections.
Pregnant women are being urged to get covid vaccination as NHS England figures report that almost a fifth of the most critically ill coronavirus patients in hospitals in recent months have been pregnant women. Of those patients receiving the highest form of life-saving treatment in intensive care – a lung-bypass machine (ECMO) – 17% were pregnant women who were unvaccinated.
The Chief Midwife, Jacqueline Dunkley-Bent said that the figures act as a "stark reminder that the covid jab can keep you, your baby and your loved ones safe and out of hospital”.
The Vaccine Data Resolution Service (VDRS) aims to resolve missing or incorrect vaccination records for people vaccinated in England who have a current NHS number and who are registered with a GP practice in England.
The service consists of two main elements:
Outbound service: A pilot of outbound calls was launched in August to patients identified as having a second dose but where no first dose is showing on the national immunisation database. This service continues to operate.
Inbound service: This element is accessed by a referrral via 119.
Please note that 119 and VDRS call agents will not provide clinical advice and cannot assist at this time with queries related to vaccinations received overseas. If the query relates to personal information that is incorrect on the patient record (e.g. name, address), these will still need to be resolved by their GP practice.
If you believe that you have missing or incorrect COVID-19 vaccination data for a vaccine that we did not give you, please call 119 and ask the call agent to make a referral to the VDRS team on you behalf. The VDRS team will then call you back within 5 working days.
For errors related to vaccines that we gave you, at the Church Farm hub, please contact us and we will pass you details to the appropriate team to get the problem resolved.
Ring 119 Covid vacc pageInvites are now being sent out for those patients aged 50 and over and those with at-risk medical conditions, who had their second covid jab 6 months ago. If you get an NHS invite (by letter, email or text), you have a choice. You can book at a mass vaccination centre, or you can wait till you get your invite a the local vaccination centre, i.e., Church Farm here. It's up to you.
In some cases, where it is appropriate and if you are eligible, you may be offered a flu jab at the same time. However when you are actually in flu clinic, this will be for flu vaccination only, as the two injections are not ideally suited to be mixed together within one clinic, given that a 15 minute wait is still required for covid vaccine.
More information can be found on our covid vacc page.
Covid vacc page NHS: Covid booster vaccinationPeople who are unable to be vaccinated and/or tested for medical reasons can now apply for proof that they have a medical reason why they should not be vaccinated and/or tested.
There are in fact very few medical conditions that would exempt you from having covid vaccination. Some examples are below:
If you get this proof of medical exemption you’ll be able to use the NHS COVID Pass wherever you need to prove your COVID-19 status within England.
In order to apply for a covid pass medical exemption, please ring 119 to ask for an application form. Once you get the form, fill it in then return the form to the relevant clinician on the form; this might be the GP, specialist or midwife.
More details about the service and the process of application can be found on the link below.
GOV: COVID-19 medical exemptions Ring 119
Our first clinic was held on Sunday just gone, October 10. We are pleased to say that it went very well, with us managing to jab just over 1,000 patients. Everyone moved through the building in an orderly fashion, face coverings on and social distancing themselves without being asked to. In fact, everything went so smoothly, and we had no queues, that to be fair, we could have probably vaccinated more patients in a safe manner.
The staff enjoyed the camaraderie and it was good to meet up together as a team, even though it was still within a work situation. And it was so lovely to see lots of familiar faces again in a more relaxed atmosphere albeit for a brief moment. We are also grateful that quite a number of you took the opportunity to thank us for our work over the last 2 years. This was even more gratifying, given that there is so much negativity about GP surgeries in the press at the moment. And a big thank you to the patient who brought in a huge bag of chocolate bars for our staff - very much appreciated!
Quite a number of patients did not turn up to their booked appointment though, which was somewhat disappointing, as obviously we had allocated flu jabs to these patients as part of our distribution. Hopefully those who missed their appointment will rebook into one of our other clinics - it will be good to see you!
Details of flu clinics can be found on our flu page.
We encourage all eligible patients to have a flu jab.
Those aged 50-64 years old, who are not in a clinical risk group, are also eligible this year, however, please note that this group will not be sent for until after all clinical at-risk patients have been given a chance to have a flu jab.
Flu page Online form to book flu jab
The blood bottle manufacturer has now completed improvements to its manufacturing facility in the UK and expects its production capacity to recover through September.
These developments, alongside the efforts of NHS staff to manage use, mean that the supply situation is no longer as constrained as at the end of August. However, the issue is not yet completely resolved and GPs have been urged to continue requesting blood tests with caution.
Blood bottles page NHSE: Becton Dickinson blood specimen collection - supply disruption
We are getting patients contact us asking for a letter or some form of confirmation that they are fit to drive. We can confirm that GPs cannot offer their opinions on whether patients are fit to drive, regardless of what the DVLA or anyone else might say. It is actually for the DVLA to decide if any person is fit to drive.
A doctor's role is limited to advising patients on medical conditions that would affect driving and providing information to or examining patients for the DVLA and to notify the DVLA if they are aware that a patient is likely going to drive against medical advice. A patient's responsibility is to notify the DVLA if they have a medical condition that could affect their driving.
Ultimately it is the DVLA alone that decides if a patient is fit to drive, not your GP.
There is a DVLA leaflet called 'Can I drive while my application is with DVLA?' that is currently circulating which quotes Section 88 of the Road Traffic Act and which states 'Your doctor must have told you that you are fit to drive'. This is actually not correct, as outlined above, and GP leaders have asked the DVLA to withdraw the leaflet and remove references to asking the GP for an opinion on fitness to drive.
If you are notified by the DVLA to get confirmation or a letter from your GP to confirm whether you are fit to drive, please deflect this back to the DVLA and ask them to conduct their query through the proper channels, which may involve their own medical officers making a clinical decision or with them formally asking us for a chargeable medical report.
Mental health disorders continue to have a huge impact upon our patients' lives and the workload of the practice. In order to help our patients, we have updated our mental health page to bring together all the links and resources that are available for patients to access at this difficult time.
In time, we intend to update the page further so that it will become the 'one-stop shop' for patients to refer to when seeking help for their mental health condition.
In the meantime, patients with anxiety, low mood and other mental health disorders are very welcome to visit the page to start accessing the help that they need.
Mental health page Self-referral index
Are you worried about your health? But do you also smoke?
With Stoptober now upon us, we present a timely article on smoking.
If the answers to both of the questions above is 'yes', then it might help you to learn what you can do to help allay some of your concerns.
We all know that smoking causes harm and it kills people. This article is not to repeat what is already common knowledge, as by doing so it is likely to cause people to just switch off.
Rather, it's about giving you some little 'did you know' snippets that might help you to adjust your perspective on smoking and encourage you to stop.
If you are encouraged to stop smoking, please visit our help page to start making moves towards reducing your risks and in turn, reducing any health worries you might have.
Stop smoking page NHS Stop Smoking NHS Quit Smoking App (iOS) NHS Quit Smoking App (Android) Self-referral index
As part of our set-up of self-referral pages, we have set up a new page to assist those patients needing the help of specialist sexual abuse services.
For help and support in the case of sexual abuse, sexual violence, assault and rape, please contact the specialist services listed on the page.
Specialist sexual abuse services page SV2 downloads EMCYPSAS Information and FAQs NottsSVSS information downloads Self-referral index
We continue to welcome feedback on any aspect of care you may have received, or an interaction that you have had with a staff member or the practice in general, or any comments you have to make about our news updates. Thank you to all patients who have taken the time to get in touch with us.
Dear Author, the update was really good and included a couple of things of which I was unaware, such as the new name for a walk in centre being a UTC, and clinical advice updates. I laughed my head off at Schrodingers GP!! I have been trying to advise to my youngest, who lives in , regarding finding a new GP and to help I went through a list of GPs on the CCG and checked their websites to get a feel for the GP surgery and I was pretty shocked. On most of the GP websites up there, there is not a lot of coverage about GDPR and not one of the sites had anywhere near the amount of useful information that your surgery has on your website, so thank you for all of your hard work. Please thank your receptionists for the response to our request for a phone appt. for Mum. The lady was lovely and reassuring and kind. – JW
Thank you for your email. I found the infomation contained in this communication very helpful. Hopefully I may never need any of the services listed but it’s helpful to know which route to take if necessary rather than going straight to the GP. - – MF
Thank you for everything that you’ve all done during the pandemic, you’ve all been marvellous - – KP
Thank you so much, you're doing a fabulous job all of you! – AM
It has been a hideous few months what with unrelenting workload, dealing with staff shortages, working long hours, whilst being subject to abuse and intolerance from all quarters. It has never been more demoralising when all our staff have been working so hard to be told that we are all lazy, obstructive or hiding away in our offices.
We hope you all know that we are doing our very best for all of you under extremely difficult circumstances and we will definitely keep going, until we all get right through to the other side.
Please take care all of you.
Kind regards
Written by Dr M. Wong
© Dr Michael Wong 2022