So you can’t see your doctor this week – even though that nagging pain has got you worrying right now.
No chance of reassurance then, for days. In just a few years our impression is that trying to see your doctor has worsened, either because an ageing population makes more demands on our GPs or the doctor's surgery has just not been a priority for our cost-cutting government.
The pressure may be on us as patients - but what’s it like from the other side of the doctor’s desk? I wanted to find out for myself, so I asked the people on the front line. Labour parliamentary candidates in Bristol West, Bristol East and Bristol North West carried out a survey of 13 surgeries across the three constituencies this summer and the quotes and information in this article come from the results.
Your family doctors (General Practitioners or GPs) work on average 10 hours per day in Bristol. Some GPs said that changes in structure have affected the time they had for people.
“I think it is important to say that the additional tasks wanted by Clinical Commissioning Groups, Public Health and NHS England have increased workloads massively. The number of meetings we are asked to attend is seriously affecting our time with our patients," said one GP.
What concerns everyone is that the scale and impact of government changes is preventing doctors from doing what we all want – making ill people better, keeping people healthy.
Almost every GP or practice manager said that they were finding it difficult recruiting new GPs in the last few years. The reasons highlighted include: pressure and stress of work, increasing workload, uncertain future, the impact of bureaucracy on doctor-patient relationships. There is a range of problems but the outcome is the same – difficulties in recruiting staff, which is leading to severe challenges for the future.
“It’s not just doctors. Nurses are hard to come by.”
“My practice is overwhelmed, there are not enough doctor appointments to meet the demand.”
At party conference season the government said they would find the money from cuts elsewhere for more doctors and more nurses - they know they’ve not been good enough on the NHS. Labour had already said that they would find £2.5billion from a mansion tax and other tax changes to fund 8,000 doctors and 20,000 nurses.
But back to our GPs right here in Bristol. The number of registered patients range from 3,400 (this particular practice serving an area of affluence, with three GPs) to 24,000 (this one serving an area of social deprivation, with 12 GPs). The average number of patients per practice responding to this survey is 12,000 and the average number of patients served by each full-time GP is 2,000.
However, the practice serving an affluent area had many fewer patients for each GP compared to the practices in the more deprived areas. This worries me hugely, given that babies born in more deprived areas are already likely to live nearly seven years less than those born in more affluent areas. We have to close this gap and end this dreadful and unfair health inequality.
Most practices said that they have had a decrease in income in the last three years but were expected to do more. Some survey returns mentioned patient expectations as a challenge.
“Patient demand is also increasing with high expectations of 'on the day' care and a higher level of complaining."
“Patients have unrealistic demands of primary healthcare. They waste appointments by not turning up or insisting a minor problem is urgent. They need to be better advised and informed about the use of a precious NHS resource."
Clearly we need to help people to understand which part of the health service can help them – and I believe that Andy Burnham’s plans, for the NHS under the next Labour government, with a focus on whole person care, will help.
“The NHS can often be treated like a political football, with new governments always wanting to make changes before the last lot of changes have even bedded down. The amount of time and energy within general practice (and the wider NHS) that is diverted each year from providing patient care into understanding and delivering the latest top-down edict and change programme must be significant."
People were not against change as such, they recognise that changing evidence, knowledge about illness and treatment and social conditions require changing practice. But the endless cycle of administrative and organisational change has to stop.
“We are fed up with the negative press we get. GP workload has increased massively over the 10 years I have worked here and the NHS generally relies hugely on staff goodwill and dedication to their patients and colleagues. It is demoralising to not be able to meet patient expectation and a lot of resource is wasted on patients who really don’t need to be seen/treated."
So, GP practices in the three constituencies who responded are struggling to cope with increased demands, decreased funds and a radically changed and changing structural and political context. They are struggling to recruit new GPs and are concerned about the future and the impact on patient care. Problems with political context and demands, patient expectation and NHS structures all emerged as themes in the responses.
I’m proud that Shadow Health Secretary, Andy Burnham, has said clearly that Labour will stop the preference for NHS contracts to go to private companies, will scrap the current changes demanded in the NHS and Social Care Act and will introduce genuine whole person care. Whole person care is the right approach for the deprived areas of our much-loved city.
He wants health and social services to work together in the interests of people’s health and well-being, including mental health. I’m proud to be campaigning for this, and for the increases in numbers of NHS doctors, nurses, careworkers and midwives Andy is going to be able to bring in through other changes to the taxation system to make sure we can afford.
This comment article by Thangam Debbonaire was posted on Bristol 24/7 on 14 October 2014.