Senior doctors have warned that practice staff and GPs are quitting after an unprecedented and escalating wave of abuse from patients that has followed weeks of public pressure over face-to-face appointments.
Practice managers, receptionists and doctors have spoken of daily confrontations with patients over issues including appointments, vaccinations and blood tests.
Many practices are maintaining Covid-19 protocols to prevent the spread of the virus, including the use of face masks; some patients have refused to wear them and become abusive when asked to do so.
The number of permanent GPs has been declining steadily over the last five years – down by 1,904 since 2016, or about 7% – to the point that by March this year there were only 26,805 remaining in post.
The prime minister said on 22 September that the remaining GPs would have to deliver a further 50 million appointments, saying it was “only reasonable” that people should be treated in person.
Figures released last week by NHS Digital showed that GPs conducted about 25.5 million appointments in August, including 1.5m Covid vaccinations, compared with 23.8 million in August 2019. Remote consultations remain higher than they were before the pandemic, with 42% of consultations conducted by phone or video link.
Professor Martin Marshall, chair of the Royal College of GPs, said: “The criticism that has been directed towards GPs and our teams in some parts of the media and by some politicians in recent weeks has been some of the worst in memory. It’s incredibly demoralising and unfair when you’re working hard, trying to do your best for patients in as safe a way as possible, to consistently be told you’re not doing enough.
“It’s having a dangerous impact on the mental health and wellbeing of GPs and our teams, but also our relationship with our patients, with numerous reports of practice staff being on the receiving end of abuse from frustrated patients.
“Our primary fear is that this unfair scrutiny, on top of existing pressures, will be the final straw for many GPs and other practice team members, causing them to leave the profession before their time.”
He called on the government to demonstrate support for GPs and admin staff and urgently make good on a pre-pandemic commitment to recruit 6,000 GPs and 26,000 staff.
Javid was challenged on Radio 4’s Today programme on Saturday about his support for newspaper campaigns after Dr Rachel Warrington, a GP partner in Bristol, said he had not supported GPs and had “no understanding” of what was happening in surgeries.
The health secretary said he wanted to work in partnership with GPs and reduce their administrative workload, but did not accept that some face-to- face appointments were unnecessary.
Javid admitted that face-to-face appointments at pre-pandemic levels were undeliverable at the present time. “At the moment, we are in discussions with GP leaders… and they’ve brought up some, I think, excellent ideas and points about what more can be done.”
Angelika Slon, who manages a practice in south London, said she was seeing a large number of staff absences as a direct outcome of abuse by patients and the rapidly increasing workload.
“There are a lot of lovely patients,” she said. “But the amount of rudeness has skyrocketed. We are understaffed – I recruited two new receptionists over the summer. One left within a couple of days and the other left after a week and a half, because they couldn’t cope with the pressure.” Existing staff are also leaving, she said.
At the beginning of the pandemic, patients were supportive, Slon said, but as vaccination levels have increased and restrictions have relaxed, some patients have reacted badly to being told that the practice is continuing to maintain NHS infection-control measures, including wearing masks.
Among other problems were the recent shortage of blood test vials and the delay of a delivery of flu vaccines. In the worst cases, practices write to abusive patients to warn them they may be removed from their list. “It was very rare,” Slon said. “Maybe something that happens three times a year. This year I’ve written more than I ever do. In the last two weeks I’ve sent two.”
Anila Jethwa, who has worked as a receptionist in north-west London for 19 years, said: “It’s happening every day. I’m 60 next year. I’m going to look at my pension and if I can just survive on it I will retire. If I can’t, I will carry on working but I won’t work in reception.”
Receptionists often bear the brunt of bad behaviour, but GPs are also affected.
GPs who contacted the Observer anonymously spoke of the strain on their mental health. One said that he was working out his notice period. “I used to love being a GP,” he said. “But I’m so burnt out. I feel useless, scarred for life.”
A salaried GP who qualified in 2019 said: “Every day I leave work feeling broken and completely shattered. I am not really there for my family. The worst part is where patients are aggressive and hostile to the point I am close to tears, feeling like my attempts to help people and do my job are completely unappreciated.”
Dr Richard Fieldhouse, the chairman of the National Association of Sessional GPs, said there was some evidence that GPs were opting out of permanent roles altogether. “We’re getting double the numbers starting to use our system,” Fieldhouse said. “We have about 6,000 members, so about 30% of locums across the country. It’s so demoralising at the moment.”
The Department of Health and Social Care (DHSC) said that record numbers of people were training to become GPs, with up to 4,000 new starters this year.
“This government has zero-tolerance for abuse or violence directed at NHS staff,” said a spokesman for the DHSC. “Everyone has the right to work free from fear of assault or abuse in a safe and secure environment.
“We are taking action to protect staff through the NHS violence reduction programme and will support the NHS, police and the Crown Prosecution Service to bring offenders to justice.”