GPs: What do we want from them?

If you believe some newspapers it is clear what we want from our GPs - face to face appointments and nothing else. “Only 69 per cent of GP appointments across England are held face-to-face” ran a headline in the Daily Mail last year. Now, I understand - and share - the frustration of not being able to get an appointment with the doctor but surely at least a third of the time a telephone, video or online meeting would actually suit us better?

It seems to me that we are at a crossroads in our relationship with the family doctor - we can’t decide whether we want to go back to the last century when we had one GP who knew all about us and would even do home calls, or forward to a digital future where much of the contact with the surgery will be via an app but we will have full access to our medical records..

It was an email from a listener to the Movers and Shakers podcast which set me thinking about this subject. “I think there is a massive issue which I believe needs much more airplay and this is the increasing difficulty in accessing GP and primary care services,” wrote Beth from South London.

She was very unhappy with the service provided by his GP for her husband, a man in his late 70s who had been diagnosed with Parkinson’s a decade ago. He had had a sudden downturn in his condition and his consultant had ordered some tests in a letter to his surgery. But nothing happened, and Beth found it impossible to arrange a face-to-face appointment - the practice had an app to book appointments but you had to be poised over the screen at 8am and everything was gone by 8.05am. Even when she tried for a telephone appointment there. was nothing.

“In the end, “ she wrote, “I had to go and have a sit in ... literally in the surgery to get my husband an appointment.” She turned up at 7.30 am, unrolled her yoga mat in front of the reception desk, and waited for the practice to open at 8.

Eventually, she got first a telephone call then acknowledgement that her husband’s case did merit a face-to-face appointment She says the young GP they then met was great but he told them that the private company which had taken over the practice “was mainly concerned with numbers and people with complex diseases like my husband didn't fit their model where you have lots of telephone appointments for simple things and that was how they got the numbers.”

When I had a call with Beth, it was clear she was no Luddite. She said her own GP surgery had the right balance - she could ring up and get a repeat prescription or when she wanted to discuss the results of some blood tests, she could book a face-to-face appointment. The surgery used the NHS App which she preferred to the private sector app. But she says the key difference is that she can use the app to book an appointment in advance at a convenient time. At her husband’s GP practice all appointments are on the day and you use their app or make a call to be allocated a slot - and wait for a call back:

“You don't know when they will call you that day so you basically need to ensure you have your phone on you at all times and haven't the misfortune to go to the loo or to the shops.”

It strikes me that the real problem here is not about the use of technology, whether that is apps, video and online consultations with the GP or simple phone calls. A University of Manchester survey of nearly 12,000 patients carried out after the widespread use of online consultation systems (OCS) during the pandemic found that most of them were positive about the idea. While we always hear that this kind of system will exclude older patients that appears not to have been the case: “Many older participants,” says the research paper, “found the system easier to navigate than expected and often preferred using it to contact their GP practice than traditional methods.”

No, the real issue here is our old friend communication, as the Manchester researchers found when asking patients about the negative side of the move online: “Poor communication about the OCS often left patients disappointed and frustrated.”

That is certainly how Beth, an American who has lived in the UK for 34 years, felt as she tried to navigate the system on behalf of her husband. She now feels they are in better shape, having finally met a GP who swiftly introduced them to the District Nurse service. But she fears others won’t be so fortunate:

“What about all the other people with Parkinson’s who don't have a bolshy North American willing to plonk herself down on the floor in front of the reception desk like me?”  

Whatever we want from our GPs, we don’t want access to them to be limited to those with sharp elbows. Primary care is going through a much needed process of digital transformation but GPs must be careful to retain the human connection with their patients that is still so valuable.