The media is putting more focus on #NHSCrisis
You see reports from wards, hospitals, Emergency Departments, Ambulances of the immense pressures faced by my colleagues in secondary care
But what does this crisis look like in #primarycare?
A thread 🧵...
You see reports from wards, hospitals, Emergency Departments, Ambulances of the immense pressures faced by my colleagues in secondary care
But what does this crisis look like in #primarycare?
A thread 🧵...
I've been a GP for 15 years
GP + #primarycare has always been busy
Balancing access, demand + capacity has always been a challenge
But honestly, things are different now.
We don't have trollies in corridors or ambulances queuing outside.
But this doesn't mean there's no #GPCrisis
GP + #primarycare has always been busy
Balancing access, demand + capacity has always been a challenge
But honestly, things are different now.
We don't have trollies in corridors or ambulances queuing outside.
But this doesn't mean there's no #GPCrisis
This is not something that has happened overnight
The current "perfect storm" of flu, covid, respiratory illness and lack of social care has exposed and exacerbated long term cracks that have become gaping holes in the system...
So what are the issues in GP?
The current "perfect storm" of flu, covid, respiratory illness and lack of social care has exposed and exacerbated long term cracks that have become gaping holes in the system...
So what are the issues in GP?
Staffing and recruitment:
When I qualified, there were 20 or more GPs applying for GP partner posts. Now there are regularly ZERO applicants
The number of patients we deal with each day has increased. An ageing population, especially in deprived areas, mean that people have...
When I qualified, there were 20 or more GPs applying for GP partner posts. Now there are regularly ZERO applicants
The number of patients we deal with each day has increased. An ageing population, especially in deprived areas, mean that people have...
More complex health issues. This means they need to consult more often, and the consultations take longer.
To compensate we have expanded our teams with nurses, pharmacists etc.
But this has only had a limited impact. Other professionals in primary care increase quality, but...
To compensate we have expanded our teams with nurses, pharmacists etc.
But this has only had a limited impact. Other professionals in primary care increase quality, but...
Don't always reduce GP workload as much as you'd expect.
So more GPs are working as salaried (employed) or locums, rather than partners. This means there are fewer partner GPs to pick up the slack and the "invisible" work in primary care
So more GPs are working as salaried (employed) or locums, rather than partners. This means there are fewer partner GPs to pick up the slack and the "invisible" work in primary care
We have pharmacists to deal with prescription issues which used to take up several hours a day of GP time. We train up staff to deal with straightforward hospital letters
But this freed up GP time has been soaked up by increased demand and complexity.
But this freed up GP time has been soaked up by increased demand and complexity.
One of the hardest jobs we have is trying to balance the demand for urgent care (problems that need to be dealt with same day) vs continuity of care and chronic disease management (stuff that needs time and focus but is often pushed back due to "urgent demand")
The constant pressure and trying to balance multiple demands has resulted in lots of clinicians going part time
I work 2 days in GP
But that's about 22 hours a week
Like many other GPs i have a 2nd post in the NHS, as working 5 days a week clinically in GP is not sustainable
I work 2 days in GP
But that's about 22 hours a week
Like many other GPs i have a 2nd post in the NHS, as working 5 days a week clinically in GP is not sustainable
Pressures on other services:
Longer waits for hospital appointments/operations mean more people coming back to GP more often for issues that we have limited options for
Because of "congestion" in hospitals, people are discharged sooner meaning there is more to pick up in GP
Longer waits for hospital appointments/operations mean more people coming back to GP more often for issues that we have limited options for
Because of "congestion" in hospitals, people are discharged sooner meaning there is more to pick up in GP
Until 2 years ago, I'd never come across a "no send" decision from the ambulance service. Long waits - yes. "We're not sending and ambulance" - no.
This is now a regular occurrence.
Now people with falls and possible fractures are told to call GP because there is no ambulance
This is now a regular occurrence.
Now people with falls and possible fractures are told to call GP because there is no ambulance
Pressure in GP and community services:
We have traditionally relied on district nurses, community pharmacies etc to help with pressures in GP.
But these services are also stretched
So when we get to a maximum safe capacity in GP, there is no backup.
There is no cavalry.
We have traditionally relied on district nurses, community pharmacies etc to help with pressures in GP.
But these services are also stretched
So when we get to a maximum safe capacity in GP, there is no backup.
There is no cavalry.
And all of this adds up.
Lots of NHS staff talk about "burnout"
In primary care, although much of what we do might not have the immediate "life or death" implications as doctors in resus in A+E, GPs are making hundreds of clinically important decisions a day.
The more decisions..
Lots of NHS staff talk about "burnout"
In primary care, although much of what we do might not have the immediate "life or death" implications as doctors in resus in A+E, GPs are making hundreds of clinically important decisions a day.
The more decisions..
You need to make in a day, the more likely you are to get something wrong. This constant pressure + concern, having to prop up a failing system, leads to burnt out clinicians.
Like many colleagues I've had therapy, medication and time out to deal with this- this is now normal
Like many colleagues I've had therapy, medication and time out to deal with this- this is now normal
You may have to take my word for it for now, but i have never known primary care as busy as it is now.
The rate of practice closures and contract resignations is accelerating.
Primary Care is not sexy. We rarely make the headlines, other than about perceived lack of appointments
The rate of practice closures and contract resignations is accelerating.
Primary Care is not sexy. We rarely make the headlines, other than about perceived lack of appointments
We are not at our best currently, but demand and need is up, work force is down, and we are constantly filling in cracks in other parts of the NHS.
No matter what your opinion of primary care and GPs, if practices fail there is no other part of the NHS ready to step in
No matter what your opinion of primary care and GPs, if practices fail there is no other part of the NHS ready to step in
Just a quick addition to this thread
I described issues in #primarycare because that is what I know
Other sectors in NHS and social care have similar issues
And that's the problem- there's no resource to redeploy as we're all in the same boat
All across the UK
I described issues in #primarycare because that is what I know
Other sectors in NHS and social care have similar issues
And that's the problem- there's no resource to redeploy as we're all in the same boat
All across the UK
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