As GP I am appalled by union hostility

Renee Hoenderkamp and Kevan James

October 15, 2021.

The crisis gripping general practice is only worsening by the day. Battered by Covid, beset by staff shortages and overwhelmed by soaring demand, the traditional model of the family doctor is starting to break down.

Since 2015, the NHS has lost 1,800 GPs, and more than half of those who remain are now working part-time – even though the British population is growing rapidly and healthcare grows more complex every year. So yesterday’s news, splashed on the Daily Mail’s front page, that Health Secretary Sajid Javid is launching a new ‘revolution’ in GP access should have been widely welcomed.

Indeed it was – and certainly among patients. But not in the bodies representing GPs.

Under the new scheme, all patients will be able to see a doctor face to face if they want to. Family doctors will also be offered an extra £250 million to improve patient access – but will be named if they fail to deliver.

It seems like a sensible solution to a growing problem – one that the Mail has highlighted in its admirable Let’s See GPs Face to Face campaign. And yet I am truly appalled by the hostile response of my own profession’s representative bodies – the British Medical Association (BMA) and the Royal College of General Practitioners – to the Government’s plans.

Dr Richard Vautrey of the BMA said he was ‘hugely dismayed’ with the package. ‘It offers very little and shows a government out of touch with the scale of the crisis on the ground.’ Gallingly, he added: ‘It is disappointing to see there is no end in sight to the preoccupation with face-to-face appointments.’

Preoccupation? Face-to-face appointments have been the way of all medicine for millennia. Yes, technology has enabled new ways for doctors to see their patients – but I bet that future generations will never shift permanently to online. The benefits of face-to-face meetings are too clear.

The BMA’s remarks were bad enough, but the Royal College of GPs has gone much further, claiming that ‘malicious criticism’ from ‘politicians and certain sections of the media’ had driven the Government to act.

That is an outrageous claim. The new measures for GP practices do not stem from some ideological agenda – far less from criticism in the Press – but because the British people overwhelmingly want a glaringly inadequate system rapidly improved.

In August this year, about 58 per cent of GP appointments were in person, down from some 80 per cent in August 2019, before the pandemic. The government order from March 2020 for GPs to switch to telephone and online appointments has now been rescinded – but many doctors seemingly prefer it that way, even though opinion polls show that over two-thirds of Britons want the right to see their doctor face to face.

As a GP, I strongly believe that family surgeries should offer patients a real choice, not dragoon them into virtual appointments. After all, the public pay our wages – and we should respect their wishes.

Online or phone consultations were justified during lockdowns and certainly benefit some younger people with minor ailments or for simple issues such as repeat prescriptions.

But now these consultations are in danger of becoming permanently entrenched. The fact is that a doctor’s reassuring touch is meant to be at the heart of general practice, which can be as much about providing emotional support as meeting clinical needs.

In my own practice, I have met new mothers, for example, who have not felt able to talk about their problems over the phone. They open up to me only when we have established a rapport and a position of trust after meeting in person. Other patients may claim at first to be feeling all right, but their body language – which could not be captured on screen or over the phone – tells a very different story.

I have also known patients to come to see me about a minor rash and then, just as they open the door to go, find the courage to say: ‘It’s probably nothing, Doctor, but I have been getting these pains in my chest.’

A patient can reveal much about their condition just by their posture and gait. What is the cause of that limp? Why are their eyes slightly bloodshot? All this crucial – and often life-saving –information can only be discovered in person.

The BMA must learn this lesson. But for decades, it has resembled a privileged gentleman’s club: smug, complacent and unrepresentative of front-line medical professionals. Increasingly, the BMA is acting like a militant trade union, endlessly peddling grievances, defending the indefensible and battling to protect restrictive working methods.

In the process, the BMA is playing a very dangerous game, one that could herald the destruction of general practice as we know it. I often say to my colleagues that, through its resistance to any type of reform, the BMA could end up doing us all out of our jobs.

Blind intransigence by the trade unions at British Leyland in the 1970s ultimately wrecked Britain’s biggest domestic car producer, just as the unionist Arthur Scargill’s stubbornness in the 1980s accelerated the demise of the coal industry. If the BMA refuses to adapt, it could find that the Government simply begins to bypass GPs.

Remote working, which the Association now so keenly embraces, could be used as a weapon against general practice, as consultations by virtual providers become more and more common. Similarly, more elements could be siphoned off to pharmacists, walk-in centres and private clinics. Indeed this process has already started, with Boots pharmacists soon to offer £15 GP-style ‘health appointments’, diagnosing conditions and even writing prescriptions. Having complained so much about their oppressive workloads, GPs could eventually find that most of the job has been sliced off and transferred elsewhere.

To avoid that fate, they should return to their moral roots as family doctors – and simply ignore the BMA.

Renee Hoenderkamp is an NHS GP

© Renee Hoenderkamp / The Daily Mail 2021

Images © The Daily Mail

Opinion

Kevan James

Dr Hoenderkamp is entirely correct in her comments.

The BMA and Royal College of GPs are nothing more than left-wing unions whose leadership see their role as Tory-bashing activists.

I would go further however, and suggest that the BMA and the Royal College should and must be shut down with its leadership banned from any further involvement in healthcare - at any level.

Not only that but I would go further still; the NHS, as it exists in its current form, must also be closed down in its entirety. Its shambolic, inefficient and extraordinarily costly management members must also be banned from any further involvement in management of anything - their gross bungling and criminal cover-ups of innumerable scandals (many involving the deaths of patients, including the newly-born) should result in prosecutions and draconian prison sentences measured in decades.

If we do this to drunk drivers and other offenders, including perpetrators of abuse, similar sanctions must apply. Then start again with a clean sheet of paper and create a new health service. A real one that actually puts patients first.

GPs have both a moral and a lawful obligation to actually see patients and to ensure that making appointments is simple and straightforward. And without insisting people in pain and difficulty make phone calls at 8.30am - calls that usually result in interminable waiting for an answer (at considerable cost to the caller) before being told that there are no more appointments available.

GPs must stop hiding - and hiding behind the myths that some (not all but far too many of them), along with other 'scientists', have allowed to flourish over COVID-19.

The same applies to so-called politicians - both Labour and Conservative - that enabled this farce to gain traction. This includes the unlamented and unmissed Matt Hancock, whose enthusiasm for online consultations started this particular ball rolling.

For far too long politicians have boasted about 'recruiting the best from the rest of the world' and bringing them to the UK. Why do UK governments think they are entitled to steal 'the best' from elsewhere because they are too short-sighted and too incompetent to re-establish UK-based recruitment and training for UK citizens to become the Doctors, Specialist Clinicians and nurses needed?

One of the side effects of government policies (again both Labour and Conservative) has been a rush of people from other countries into the NHS - and some of them have subsequently been shown to have used fake qualifications. Some of them can't even speak English properly. People have died because of them. The NHS is awash with people who are little more than foreign mercenaries leeching untold millions from the British taxpayer.

This country, its healthcare system and its people desperately need politicians with the courage and moral fibre to tell the truth about the NHS, to stop using it for political point-scoring and restore it to what it once was and could be again.

Whilst we continue to select and elect cowardly, bandwagon-jumping non-entities to Parliament and thus government, until we have men and women of substance, real-life experience and talent running the UK, the NHS will continue to rapaciously devour unimaginable sums of money and those three letters will continue to stand for 'No Hope Service'.

And it will carry on killing people.

© Kevan James, 2021

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