Have you managed to see your GP lately? I mean, actually see them in person, not on a screen, or heard them during a consultation down the phone? Or have you, perhaps, been asked to send the surgery a photo of the tumour on your leg, which is what one reader tells me happened to her 94-year-old mother?
If you have seen a GP, congratulations! You are one of the lucky ones. What follows is a story about a lovely woman, a beloved wife, mother and dear friend, one of the tens of thousands who wasn’t lucky.
Back in November, Nick Stokes emailed the Planet Normal podcast to protest that the NHS was being turned into the “National Covid Service”, and misinformation was being spread about hospitals being overwhelmed. “If there is a shortage of beds, that happens every single year – it is not due to Covid! I can remember several years of black alerts, ambulances unable to unload etc due to flu cases, but I don’t remember everything else being cancelled or people being told to stay at home.
As the former chair of a major NHS Hospital Trust, Nick knew what he was talking about. In February, he wrote to us again, this time with shocking personal experience of the National Covid Service. “I would never have imagined the nightmare we have now had. Since the summer, my wife Joy has been complaining of leg and bottom pains to our GPs on the phone, only to be fobbed off. The doctors put it down to arthritis. Yet my wife previously had breast cancer 15 years ago, which should have rung alarm bells.
“The pains worsened in October, but the receptionist still refused to make a face-to-face appointment, saying we could be given a telephone one but no more.
“Due to Covid, face-to-face was said to be for emergency only. We were told we could self-refer to physio (the surgery wouldn’t do it), yet, when we did, all the physio would do was a phone consultation followed by some exercises. Our GPs ignored our increasingly frantic requests (and letters from physios) for an X-ray or scan. Weeks passed and Joy’s condition continued to worsen until she could not walk unaided. Eventually, her pain became so severe, I demanded painkillers. Only then did the GP book her an X-ray for early January.”
The X-ray revealed that cancer had eaten into Joy’s hip and femur. A major operation followed. Nick was utterly distraught on behalf of his wife of 46 years. “Is it surprising that we are both bitter and traumatised? This, Allison, is the truth of what happens when Covid is all that matters. If I hear Matt Hancock say once more that GP and hospital services are looking after all those who need the NHS, I will scream. If I hear him boasting that GPs can now provide the same service through telephone contact, I will throw something at the TV.
“The truth is very different. Our GP actually admitted that he was horrified how my wife had deteriorated when he eventually saw her in person! The cancer that was not diagnosed because our GPs would not see patients face-to-face has spread, not just to Joy’s bones, but into her brain. She is too weak to commence the full cancer treatment. Joy is fearful and frightened while I cannot contemplate life without her. Turning the NHS into the National Covid Service has caused my wife and I endless pain and suffering.”
Joy Stokes’s funeral was last Thursday. She was 69 years old. Nick said it was a struggle to get the numbers down to 30 for a Covid-compliant service “for somebody as popular as Joy”. It is a mark of the woman that her very last visit, when she was clearly dying, was to console a friend in the village whose cancer was also terminal.
Nick has given me permission to share his darling wife’s story with you because he wants those GPs who are still hiding behind their receptionists to know that reserving face-to-face appointments for “emergencies only” can be a death sentence.
With pubs and restaurants doing their level best to offer a service outside under an awning in the foul weather, with hairdressers cutting hair wearing PPE, with Covid deaths reported as one on Monday, what possible excuse do GPs still have for not seeing very sick, scared people like Joy Stokes?
Before Covid, around eight out of 10 GP appointments were conducted face to face. At the height of lockdown, in April 2020, that figure reportedly fell to between seven and eight per cent. The widely lamented failure to resume appointments in person has given rise to the suspicion that GPs will never get back to normal. Indeed, Covid is being used as cover for driving though a change in working practices which would be abhorrent to most British people, should they ever be consulted.
One Telegraph reader tells me she recently had a letter from her doctor saying that, henceforth, he would only offer video appointments. Richard, another reader who, after a fortnight, finally managed to get through on the phone, was told by his doctor that she needed to know his blood pressure before she renewed his medication.
“Great, at least I get to see her in person!” thought Richard. Not a bit of it. He was frankly astonished to hear the GP suggest that he buy a blood pressure monitor – “You can get one for around £20” – and do the reading himself. No further prescriptions would be issued until Richard told the doctor his blood pressure.
Is this what the future holds? DIY diagnosis which spares GPs the tedium of having to, you know, do their job? Just to be on the safe side, Marjorie, I’d purchase some goggles and a chainsaw for an impromptu, at-home amputation.
How many GPs support these innovations which fly in the face of good medical practice as it has been taught for centuries?
“I listened to Nick’s email about his wife on Planet Normal and I felt embarrassed to be a General Practitioner,” wrote Andrew from Devon. “The failure to see patients face to face has been awful. I hate it! We are trying to assess people, over the phone, with every symptom under the sun e.g. pain, breathlessness, weight loss, depression etc. It’s impossible. I’ve been trying to see patients face to face throughout this whole crisis. I lobby my fellow practice partners about returning our surgery back to normal, but sadly they remain cautious about a waiting room full of people. This is despite over 90 per cent of our patients aged over 50 having been vaccinated! Why are so many so-called ‘educated’ people still scared? I recently had a couple of cases where, were it not for seeing the patient face to face, the patient might no longer be with us. The thought makes me shudder. I desperately want Nick to know that there are GPs out there who have continued with face to face consultations as we know this is all too often the best way.”
Others GPs have emailed to tell me about their own Joys, patients whose cancer could have been picked up if only they’d been examined in person. “This afternoon, I saw someone in his forties with Stage 4 lung cancer,” writes Claire, a GP in east London. “Poor guy doesn’t stand a chance.”
Like Andrew, Claire has pleaded with colleagues to go back to normal surgery, seeing all patients face to face, but she’s been told this is “not allowed because we can’t do the social distancing required in our small waiting room”. At the moment, any patients fortunate enough to be seen are given a specific time to come in, well apart from other face-to-face appointments. “Apparently, there are no plans for this to change,” says Claire, “I’m thinking of leaving my job. This is not patient care, I feel like an administrator.”
Who or what is responsible for this insidious, deeply worrying revolution in primary care? One practice manager says that NHS England dictates Standard Operating Procedure and that GPs will be breaking their contract (with regard to patient safety and wellbeing) if they return to the previous pattern of working. Doctors are still expected to see face-to-face those that need it, “but NHS England expect that to be a definite minority”.
The guidance says GPs can’t go back to the way things were unless patients in the waiting room can be socially distanced, and most surgeries have small waiting rooms where that isn’t possible. Plus, the consulting room has to be cleaned down after each patient, so they can only see half as many patients as previously.
Honestly, how pathetic! If The Dog and Duck can put up a marquee in the car park to serve drinks, why can’t GPs think creatively and do the same for blood tests? Most women would gladly have half a shandy with their smear test.
Behind these sly manoeuvrings, I fear there are other, financial, concerns at work. A recent report said that demand for GP appointments has soared in the last year, at the same time as thousands of extra GPs promised by the Government have still to materialise.
Back in April, Matt Hancock said that “patients who have got used to online GP and outpatient appointments during the crisis may not want face-to-face appointments when things go back to normal”. The Secretary of State stressed that the NHS “must not lose” the digital “advances” that have been made during the Covid-19 pandemic.
Advances for whom, Secretary of State? They’re not advances if you’re a woman called Joy with excruciating pain in your leg who couldn’t get to see a GP who would probably have taken one look at her and referred her for an urgent scan, which would have found her cancer earlier, and enabled her to start life-prolonging treatment.
Here’s the thing, Mr Hancock. Most people still want to see a GP, not send them a photo of their ailment or take their own blood pressure. They don’t care to be part of your cost-cutting, digital healthcare revolution which strips the human touch from the doctor-patient relationship.
Nick Stokes asked me to tell his wife’s story so people would insist on better care from their GP and the Government might change the rules for surgeries “because at least then Joy’s suffering will end in her leaving the world with a positive legacy”. Are you able to see your GP? Are you a GP who wants to see patients but can’t? If so, please let me know. Our lives shouldn’t be at the mercy of bureaucrats who don’t care about the emotional consequences of their rules.
Let us be on the side of Joy. Not sorrow.
