Management in Practice spoke with Dr Ed Pooley, a salaried GP in Nottingham, who is set to speak about patient expectations at Management In Practice London on 14 September, the title’s first face-to-face event since the Covid-19 pandemic began.
Dr Pooley is the founder of Ten Minute Medicine, a teaching organisation helping medical students transition into junior doctor roles.
We know that abuse against practice staff has increased during the Covid vaccine campaign. What is different now about the way patients are behaving in practices?
What the pandemic has done is increased the background level of health anxiety that people have generally. As a result of that we are seeing a lot more anger as a secondary emotion. So, one of the responses to fear is people become angry, particularly if they can’t get what they need. If your level of health anxiety has increased and you go to your GP surgery and then you’ve got to navigate a more difficult system than perhaps the one you’re used to — one where you’re asked to speak on the phone or wait for your GP to call back — we sometimes see a more angered response to that.
That’s almost in direct contrast to the fact we’re working harder and seeing more people sooner than we would have done pre-pandemic, in most cases, because we’re able to deal with the simple stuff quite quickly.
During the Covid vaccination campaign, 75% of practice staff experience verbal abuse from patients. With the flu and booster campaigns starting up, can we expect a similar trend?
Statistically, if you are dealing with people who are stressed or frustrated and you are trying to coordinate a large number of patients to ensure a slick campaign, there is that risk that things will spill over.
What may happen is patients will see lots and lots of people coming into GP surgeries for flu vaccinations while their experience may be that they still have to call in for an appointment. So, you’d have a situation where people don’t understand why they can’t come in to talk about a symptom they’re experiencing, [as though] there’s a direct conflict there.
I think those kinds of things will spill over unfortunately into anger and aggression.
Has the national media’s criticism of GPs impacted how patients treat practice staff?
There’s a lot of articles, certainly within the last few months, that have been quite critical of GPs, and part of that has come from a societal level of frustration about health provision. And GPs are the public face of health in the UK, so a lot of that anger and frustration is targeted at us.
If you combine that with appearing to be less able to be spoken to [as a patient] and add in health anxiety to that, you’re going to get a lot of stories about diagnoses being missed — which would have happened anyway just on the basis of statistics.
There seems to be a lot of negativity towards GPs and lots of the familiar things which people get frustrated with GPs about are coming into the narrative: part-time working, GPs being overpaid, not being available, being incompetent. All these kinds of narratives are starting to solidify, and a lot of secondary care colleagues sadly are supporting that when perhaps they don’t fully know the situation.
CQC inspections are already stressful for practice managers and GPs. Has the prospect of patient complaints added to that anxiety?
I think there’s a huge fear that CQC inspections are going to add an additional layer of stress on top of an already high level.
One of the big challenges with the CQC is that there needs to be a mechanism by which GP surgeries are evaluated, and I think most people in primary care would agree with that. but the way the CQC assess things tends to feel more punitive: if you get too many criticisms you get shut down, you get asked to make some improvement that you may not have the funding or staffing for.
What tends to happen then is you shut down a practice that’s struggling, and those patients get transferred to nearby surgeries. That has an impact on them.
Whereas if the CQC was perhaps more formative in their assessments and were able to access pools of money or resources that they could card onto a practice, that would be the best of both world. A checks-and-balances system, but also a system which can improve the whole health economy for that area.