Sajid Javid’s tactics of “attacking and threatening” GPs with “league tables of shame” if they do not see enough patients in person risks family doctors, practice nurses and receptionists facing greater abuse and threats, the leader of Britain’s doctors has said.
Javid’s plan, which has been endorsed by NHS England, could fuel a dangerous “blame culture” against GPs, Dr Chaand Nagpaul added.
Nagpaul, the head of the British Medical Association (BMA), voiced frustration and deep unease about how the health secretary’s plan could damage the close relationship GPs – “the bedrock of the NHS” – have with their patients.
He singled out Javid and NHS England’s plan to publish regular updates on how many patients each GP practice is seeing face-to-face, take action against the lowest-performing 20% and let patients post text message reviews of their most recent experience with their surgery as measures that could turn patients against GPs.
The BMA’s GPs committee voted on Thursday to move towards holding a ballot on possible industrial action in protest at “the deliberate, relentless denigration of GPs by government, NHS England and some quarters of the media”, which could herald a prolonged battle between family doctors and ministers.
In a significant move they also made clear that England’s 6,600 GP surgeries should ignore Javid’s comments on in-person appointments and carry on seeing patients in whichever way they saw fit, given that Covid infection rates remained high and are rising.
Speaking to the Guardian, Nagpaul said: “Half of GPs have said that they are getting more abuse and we’ve seen attacks – physical assaults – on GPs and their staff. Despite that this proposal is suggesting that we have a league table of shame, with a bottom 20%, who actually may be the practices who have unfilled GP vacancies they cannot fill, shamed in a league table.
“They then want to add insult to injury by telling those practices that patients are unhappy, through automated text, and then want to bring in a hit squad and parade their ‘failing’ to their local community. I cannot see how this is going to be anything other than adding abuse to practices and practices getting more vulnerable from blame, attack and abuse.”
Dr Ketan Bhatt, a GP in Hertfordshire, told on Twitter this week how “yesterday one of our patients refused to accept a remote diagnosis of conjunctivitis for his well child. He marched down to the practice, straight into a young female GP’s room, locked the door and refused to leave until he had a face-to-face diagnosis.
“I’m stunned. When did patients start threatening GPs to get what they want?” The incident had left “a young GP scared to come to work”, he added.
It’s very high risk to be attacking a bedrock of the NHS at a time when it is in a precarious situation.
Dr Chaand Nagpaul
Nagpaul blamed a lack of government action over recent years to tackle the declining number of full-time GPs for patients’ difficulty in getting appointments, not family doctors’ refusal to see them.
“The government’s proposal fails to acknowledge the simple maths of capacity and demand. You have 2,000 fewer GPs than in 2015, when we were promised 5,000 more. You have 2 million more patients being seen [a month] compared to before the pandemic.
“I can’t understand how, with those maths and without any plans to increase the workforce, how this package of proposals is anything other than deflecting blame, on to a workforce that is already exhausted, for the systemic failings of not having enough GPs in the first place. That is the root cause of the patients access issue.”
GPs believe the fact that surgeries are standalone private businesses, and family doctors and their teams are not employed directly by the NHS, means Javid will be unable to compel them to implement his order. They are angry that he has done too little to reduce their “unsafe” and growing workloads.
NHS England’s chief executive, Amanda Pritchard, made clear to MPs earlier this week that she shared the BMA and Royal College of GPs’ view that family doctors should retain clinical discretion as to how they saw patients and telephone and video appointments were appropriate ways of carrying out some consultations.
Nagpaul, a GP in London, is worried that Javid’s plan, especially its accompanying performance management regime, will lead to more GPs quitting.
“This is a package that is likely to exacerbate the workforce crisis. This is going to reduce the GP workforce. I’m certain that GPs are going to be leaving their jobs. I’m certain that many will reduce their hours and I’m certain many will retire. It will make general practice probably the least attractive speciality in medicine.”
He sketched out a gloomy scenario in which an even greater shortage of GPs would mean Javid’s plan leading to the opposite of what it intended: fewer rather than more face-to-face slots. It could also hit the NHS’s attempt to tackle the ballooning backlog of care because the 5.7 million patients on hospital waiting lists would find it harder to get help for their ongoing symptoms, he said.
“It’s very high risk to be attacking a bedrock of the NHS at a time when the NHS is in a precarious situation. It’s dangerous to be attacking general practice, because of the impact it could have on patient care. It risks collapsing general practice. It risks general practice imploding.”
The tough new approach was doomed to fail because there were so few locum GPs to hire with the £250m that Javid had promised as a reward for expanding in-person consultations, Nagpaul said. He advised Javid to learn from his predecessor Jeremy Hunt’s year-long, bitterly divisive struggle with junior doctors in 2015-16.
“This is a time one should learn from the past, not repeat it in a situation where the NHS is in a much worse state. Jeremy Hunt probably regrets getting into battle with the profession. It didn’t achieve anything for patients,” said Nagpaul.
“This is a time when Sajid Javid should reflect on that and realise that no good can come from getting into battle with the profession and shaming them and targeting them, when in fact what he needs [to do] is support them and value them and address the root causes of the difficulties they are facing.”