A survey has found 71 per cent of GPs have experienced an increase in abuse from patients over the past year. So, what’s the reality of life as a GP in the midst of the Covid-19 pandemic? 

AFTER 21 years as a GP – a career she set her heart on when she was 15 – Helen McLeish admits to being unsure how much longer she can carry on.

It remains a job she loves, but the Covid-19 pandemic has taken its toll on the mum of two teenage girls.

The workload at her Darlington practice has soared, and the pressure is unrelenting as the biggest public health crisis in living memory continues to stretch the elasticity of the NHS.

But what’s made it so much harder for Helen, and her colleagues, is a sense of injustice that primary care often gets caught in the crossfire of public anger over changes in the way general practices are having to operate.

“In all my time as a GP, I’ve never known the intensity to be so non-stop,” she says from behind a mask in her consulting room at Whinfield Medical Practice. “At times, it’s intolerable, and yet there’s a perception that somehow GPs are to blame.”

Helen is speaking out, not to seek pity, but to try to increase public understanding of the pressure primary care is under, amid evidence that abuse at general practices is at an all-time high.

“There’s been a significant increase in abuse, not just here, but at other practices, because people are frustrated,” she says. “It’s come to something when you find yourself having to write to an elderly patient because they’ve been swearing at reception staff.”

It’s not a problem confined to Darlington, of course. Richard Vautrey, chair of the British Medical Association GPs Committee, has called on ministers and NHS England to address a nationwide “terrible trend” of abuse, harassment and physical attacks on GPs and other primary care staff.

A BMA survey this summer found 71 per cent of GPs had experienced an increase in abusive behaviour in the past year, and the Government has been urged to condemn “the onslaught of abuse and media scapegoating of GPs and their staff”.

It’s a different world today from when Helen first dreamt of a medical career while growing up in Sheffield. Her father was a civil engineer, her mother a radiographer, and Helen wanted to be a vet until her best friend’s mum persuaded her she’d make a good doctor.

Her mind was made up by the time she was 15, and her ambition was reinforced when she did work experience during her A-levels. She spent two terms at a primary school, supporting a pupil with Down’s Syndrome, and building up a strong bond with the girl.

“Having that connection made me realise my friend’s mum was right,” she says.

Years later, when she found out the girl was ill, Helen visited her in hospital before she passed away. Even now, she gets emotional at the memory.

After studying medicine at University College London, Helen chose to head north and her first job was as a house officer at Darlington Memorial Hospital, spending six months on surgical wards.

She went on to gain further invaluable experience on medical wards, accident and emergency, paediatrics, palliative care, and elderly care. She also met her future husband, Andy, who was working as a nurse.

“I enjoyed the hospital environment, but I always knew I’d end up as a GP,” she says.

Her first training job in general practice was at Whinfield in 1998. After qualifying, a two-year salaried post followed, working in surgeries around the town, before she returned to Whinfield to become a partner.

“One of the most rewarding parts of the job is getting to know local families, but the pandemic has had a massive impact on the way we work,” she explains.

When the first lockdown was ordered in March 2020, NHS England’s instruction was for GPs to move to a total “triage” system, with all initial appointments conducted by telephone to minimise the risk of infection, while a central “hot clinic” was set up for those with Covid symptoms.

When restrictions eased in the summer, face-to-face appointments resumed and, over the past year, that’s evolved into a mix of ways in which GPs can assess patients, including telephone, email, video, and text messaging.

“What’s important to stress is that processes are in place to make sure patients are still seen face-to-face if needed,” says Helen.

Nevertheless, the workload facing GPs has rocketed due to staff shortages caused by members of primary care teams having to isolate whenever household members have Covid, along with an inevitable knock-on effect from hospitals being overrun.

For example, if a patient’s hip replacement operation has been delayed because of the hospital backlog caused by Covid, it’s GPs who provide support with pain relief.

In the midst of those additional pressures, reception staff are facing increasing aggression from patients, and Helen believes the problem is being exacerbated by elements of the national media raising unrealistic expectations by campaigning for more face-to-face appointments.

Whinfield is a practice with 12,000 patients, served by six GPs, with Helen the only one working full-time. But the practice is made up of a wider 35-strong team, comprising advanced nurse practitioners, health care assistants, nurses, pharmacists, pharmacy technicians, and receptionists.

Work typically starts for Helen at 7am, completing paperwork from the previous day, before holding a surgery for face-to-face appointments between 8.30am and 11am. There’s then meant to be a break – a chance for the GPs to liaise – but time hasn't allowed for that lately. Four telephone appointments are then scheduled between 11.30am and 11.50am before home visits over lunchtime.

Afternoon surgery is 2pm to 4.30pm, followed by another four telephone appointments between 4.30pm and 4.50pm. Several extra appointments also generally come in on a typical day.

On top of that, there is an average of 100 additional daily tasks, such as scanning for test results, arranging sick notes, and writing letters.

Helen admits that the workload, together with the abuse directed at her colleagues, has made her consider her future. “I’ve thought about whether I can take my pension early, and at least reduce my hours, because there are times when it’s too much – it reduces me to tears,” she says.

And yet, she has a 16-year-old daughter, Ellie, who’s leaning towards a career in medicine. “I’ll encourage her all the way if that’s what she wants to do, but I worry about the stress she’d be under.”

With the Omicron variant spreading new fears, the extraordinary pressure on the NHS won’t be easing any time soon, so what can be done to help?

Face-to-face appointments remain part of the service but there are alternatives:

  • NHS 111 online is free to use 24 hours a day, seven days a week.
  • Community pharmacies can help with many queries.
  • Consider online consultations instead of phoning.
  • Order prescriptions in plenty of time.
  • Try to be generally fitter to reduce the chance of becoming unwell.

However, the overriding plea from Helen is for greater understanding: that GPs are doing their best in unprecedented times.

“Demand is outstripping capacity, so try to remember that all the members of the team at your local practice are people with feelings too,” she says. “Please work with us, not against us.”

GPs deserve the right treatment too.