Thread by @danielgoyal

The truth about the GP crisis...from a non-GP doctor.

I share this with you for 3 reasons:

1. To highlight the source (and fault) of the current GP crisis.

2. Because the primary care crisis is at a critical point and can be salvaged.

3. Public support matters.

We go back to March 2020, when all the health service staff were preparing for the arrival of this new, unknown pathogen. We were all nervous.

Those who expected to be right in the thick of it were:

Primary care - GPs, DN's, receptionists, etc
A&E (+ paramedics)
Medicine
ICU

For those who don't know, the typical pathway begins with the GP or Practice Nurse..

they assess, then either test and send home with advice, or send to A&E for further assessment...

if deemed 'unwell', they are admitted to medics.

That is what we were preparing for.

Then the UK government did something odd (I know, not the first time)...

"Anyone who is unwell should go to NHS111 online first for advice, rather than approaching their GP practice."

pulsetoday.co.uk/resource/coron…

By way of this decision, the UK Gov, for reasons unknown to me, removed triaging from GPs and primary care.

It did not end well [warning: thread contains information that may cause anger]

https://twitter.com/danielgoyal/status/1450265770894757894?s=20

Then the government removed the testing...

"The second pillar is the creation of brand-new swab testing capacity delivered by commercial partners" (Hancock)

assets.publishing.service.gov.uk/government/upl…

The UK gov - presumably unfamiliar with clinical practice - failed to appreciate the cardinal rule of ordering a diagnostic test: THE FOLLOW-UP.

A diagnostic test is useless unless it benefits the recipient.

NHS providers (@nhsproviders are an independent body representing hospitals and trusts from around the UK) immediately questioned it:

"Simply put, responsibility and accountability for testing was diffuse and unclear."

So an automated computer algorithm (111 online) was telling patients whether they needed medical help or not, and the Govs "commercial partners" were completing tests on people without clinical supervision or any follow-up?

Next, the UK Gov announced a "world-beating" test and trace system...whereby patients could book a test online (from one of the "commercial partners").

And then presumably be followed up?

Unfortunately not.

The Test and Trace service had NO CLINICAL REMIT...

And the patient info leaflet:

So GPs were cut entirely from the usual triage and follow-up pathway..

and patients left at home without healthcare contact.

And GPs were as shocked about this government's decision as we all were [really worth going through this thread - April 2020]:

https://twitter.com/DrSimonHodes/status/1255619596079575047?s=20

But...GPs were (and are) involved in one part of the COVID-19 pathway...

If you qualify for a test,

and you test positive,

and you make it through the '111' online triage,

and you next make it past the call handler,

and then you make it past the '111' doc or nurse...

then you are 'triaged' to Covid Assessment Centres (or GP Red Rooms), which are mainly staffed by GPs.

Why the government put in place such a convoluted pathway remains unknown.

GPs are the best amongst us (docs) at telling whether someone needs hospital assessment.

They have the infrastructure to do tests and to follow-up their patients.

GPs also have the acumen to choose which labs to use for testing...

And total primary care budget (England) is around £12bn

Test and trace budget = £37bn

Imagine how much strengthening of our health service and pandemic response we could have achieved had that money be allocated based on clinical judgement.

Unfortunately, the situation is ongoing.

1. We need an urgent public inquiry to understand and rectify the substandard clinical care pathway the government has put in place. The errors are, as evidenced, too grave and are ongoing.

2. GP leadership need to revert back to the evidence and not get scapegoated by the Government's spin. The public were and have been left to fend for themselves. The public are upset and feel betrayed...but if anything the last few days has shown us..

..it is more likely the government are 'wilfully negligent', have made bad choices, and are now looking for someone else to blame

3. We must demand the money set aside for the NOW defunct Test and Trace system be reallocated to primary and urgent secondary care IMMEDIATELY.
End

#TeamGP
On a similar vein , I wrote a letter to the PM (via Twitter). Didn't think it would come to much. But it seems to have touched a nerve with Tweeples (2K RTs + 6K likes). I wondered if you guys would give it a push...happy to stand by every word!

https://twitter.com/danielgoyal/status/1451133556609126402?s=20