Leading doctor says general practice in Hertfordshire is ‘at breaking point’

Two leading Hertfordshire doctors have told councillors that GP practices are at ‘breaking point’ – highlighting rising demand and staff shortages.

GP Nicolas Small said that his practice, in Hertsmere, could receive in excess of 800 calls from patients per day – and he outlined the ‘frantic’ nature of surgery life.

He said the intensity of their 12-hour days at the surgery was so much that it could feel like being in an ‘accident and emergency’ department.

“When you are there in the heat of the day it feels like you are going non-stop for about 12 hours – the idea of a lunch break has long gone,” said Dr Small, who is also chair of the Herts Valleys Clinical Commissioning Group.

“It’s so rapid – and that has changed so much over 25 years. The pace of general practice is so rapid that you might as well be in accident and emergency – as that’s how it feels.”

Dr Small pointed to the hundreds of calls made to the surgery a day – where patients may have waited a long time to be answered and may be ‘frustrated’ or ‘abusive’.

And he says that while he loves his job, that level of demand is ‘unsustainable’ – pointing to a general practice teetering on the point of mass resignations.

Meanwhile GP Prag Moodley, who is also chair of the East and North Herts Clinical Commissioning Group, also catalogued a typical 12-hour day at his own Stevenage practice.

He pointed to time dealing with test results, prescriptions and arranging home visits, as well as enquiries and referrals from contacts from ambulance crews, hospital consultants and NHS 111, in addition to patient appointments.

And he said general practice was “at breaking point”.

Dr Moodley said that in the past year FOUR of his practice GPs had left – attracted, he suggested, by the idea of a quieter practice or an urgent care setting, where they can deal with patients without the admin and other tasks.

And he said that in that time they had had just one applicant – who had received five job offers and had ultimately opted for another.

Instead he said they had met demand by employing paramedics and nurse practitioners.

The GPs gave the insight into general practice on Friday, October 15, at a meeting of Hertfordshire County Council’s ‘GP access topic group’.

And chairman Cllr Richard Thake said it had sounded ‘horrendous’ and said it was no longer like ‘Dr Finlays Casebook’.

The topic group was held just days after the government had called for greater access for patients to see their GPs face to face – though chair Cllr Richard Thake stressed that the ‘scrutiny’ was not designed to look specifically at that issue.

And while the report accepted that face to face appointments reduced ‘last year’, this year they are said to be in excess of 51 per cent.

It was also reported that half of all patients are now given an appointment on the same day.

Councillors were told that during the height of the pandemic digital transformation – ‘at pace and scale’ – was deliberately used to limit face to face contact due to the risk of Covid-19, with practices using telephones and having access to video consultations.

And the report by Ms Shah pointed to national instructions for practices to continue to offer a blended approach of face to face and remote appointments – also highlighting public health advice about the use of PPE and the separation of potential Covid-19 patients for infection control.

Demand for primary care – including GP services – was reported to have risen, as patients present with concerns not addressed during the pandemic, with long-term conditions in need of monitoring and looking for support while they sit on record NHS waiting lists.

And in addition to that growing demand, GPs – each with an average list of more than 2000 patients – are at the heart of the flu and Covid-19 vaccination programmes.

Patients have complained that it’s hard to get through to GPs. And councillors were told that GP phone lines are overly subscribed and, at times, have been unable to cope with demand.

David Evans, managing director of the Herts Valleys Clinical Commissioning Group, promoted the use of Think 111 First – as a way of ensuring that patients are directed to the right service.

And it was also suggested that patients should see a pharmacist or use online resources, rather than contact their GP with a minor issue – and that they should not call their practice about queries relating to vaccination bookings.

One of the main issues raised by councillors was the long telephone waits faced by patients calling up to make an appointment.

Cllr Sharon Taylor told the group she did not think there was anyone who would not appreciate the pressure GP services were under.

And she acknowledged that when people ‘got through’, most thought the service was ‘exemplary’.

But she said it was ‘getting to’ the service that was the real issue and the reason that they were there.

And she suggested communication was letting patients down – and that there needed to be improvement.

Meanwhile Cllr Dee Hart told the meeting GP telephony services were not fit for purpose.

She said patients – who could be 50th in a queue – may have to wait an hour before they got to speak to a human being.

“It’s demoralising for staff – and it’s demoralising for patients, ” she said. “We need to realise that the system at the moment is not fit for purpose for anyone,”

Chair Cllr Thake said it was important to understand the pressures from both sides.

The day-long topic group was designed to allow councillors to scrutinise the challenges facing GP surgeries and primary care, the ways primary care is managing demand and how issues will be resolved. And, following the meeting, councillors will draw up a number of recommendations.