Creating the ‘New different’

Carter Singh is a local Royal College of General Practitioners Faculty Representative on the National Council, Board Member of the Governance and Nominations Committee, Vice-Chair on the Nottinghamshire Local Medical Committee, and a GP Partner at Willowbrook Medical Practice.

General practice is both the bedrock and capstone of the NHS providing over 90% of the total NHS activity for ONLY 8% of the total funding. This system only works due to the good will of our GPs and staff going the extra mile for our patients.

GPs have consistently been ranked as one of the most trusted professions in society because we place our patients at the heart of everything that we do. So why then, is the political narrative and media portrayal of general practice so negative? Why are my hardworking GP colleagues feeling that they are being vilified and witch-hunted by both regulators and the public?

The pre-pandemic ‘old normal’ had been broken for a long time. Rather than seeking to develop a ‘new normal’ we should perhaps focus on creating a ‘new different’. ‘How?’, I hear you ask! Well …

Rather than seeking to develop a ‘new normal’ we should perhaps focus on creating a ‘new different’.

At the beginning of the pandemic we demonstrated that systems could rapidly evolve and adapt at pace to ensure efficiency of care provision. Necessity proved to be the catalyst in the face of adversity coupled with goodwill and civic duty to fuel genuine positive change. Novel ways of working that would otherwise have taken many years to develop and implement pre-COVID were safely and effectively rolled out in days during the pandemic. We need to capitalise on this system-wide ingenuity to sustain this momentum of change so we are not curtailed by complacency or inertia.

Real-world allowances, such as reductions in red tape and bureaucracy, coupled with easing of burdensome, unnecessary over-bearing regulation has been invaluable in aiding healthcare provision during the pandemic.

During the pandemic, many patients, often with serious health problems, have put off presenting to their GP for many reasons. Long hospital waiting lists and delays in presentation, diagnosis, and treatment make for a perfect storm in general practice as the pandemic subsides.

General practice is already caught in the cross-fire (as we are often the only accessible front-facing, patient-accessible party) and swamped, dealing with patients and their complaints about their frustrations about secondary care backlogs.

Healthcare providers and society at large have been conditioned into a state of hyper-vigilance during the pandemic without the adequate support structures to protect their mental health and wellbeing. Mental health problems have rocketed due to lockdowns, bereavement, financial troubles, and COVID-19. Many people have believed the rhetoric and fake news and wrongly assumed that GP practices were closed.

General practice has worked tirelessly to deliver the lion’s share of the biggest vaccine rollout in history …

Demand for GP appointments skyrocketed, so how could we have continued with the ‘old routine’ pre-pandemic way of working when the pandemic was anything but routine? We faced the challenges head on and took responsibility to design novel ways of working at pace to successfully maintain and improve access, safety, standards, and sustainability given the unprecedented circumstances.

Remote consulting had been effective in the right circumstances but it isn’t a panacea. GPs have felt paralysed by indecision after receiving mixed conflicting messages from politicians, regulators, and the court of public opinion about the use of remote consultations.

General practice has worked tirelessly to deliver the lion’s share of the biggest vaccine rollout in history, in addition to honouring its core contractual obligations. However, unclear future expectations about vaccine provision fosters significant uncertainty and anxiety. With GP numbers falling and high rates of GP burnout and suicide, the system has never been so stretched beyond capacity.

As the vaccination programme helps us to visualise the light at the end of the tunnel of the pandemic and we begin to see reductions in rates of transmission, hospitalisation, and mortality, we must not lose sight of the stress, volatility, sacrifice, loss, anxiety, confusion, conflict, uncertainty, and damage that the pandemic has inflicted on our society.

People have fought over toilet roll, argued about face coverings, and not respected each other’s personal space. Some have become generally less tolerant, forgiving, and accepting of others through social isolation. We may have become more paranoid, fractious, and irritable as a society. This can cause suboptimal communication and unrealistic, unmet, and unmanaged inter-professional and doctor–patient expectations. Tempers and tensions are running high and locally we have seen patients arrested and immediately removed from practice lists due to unacceptable verbal and physical abuse against general practice staff. Never before has general practice given so much and felt so persecuted for its efforts.

we must not lose sight of the stress, volatility, sacrifice, loss, anxiety, confusion, conflict, uncertainty, and damage that the pandemic has inflicted …

As conditions in general practice become unbearable, it can be all too easy to start turning on our colleagues and patients, pointing the finger, naming and shaming, and playing the blame game. However, patients and their GPs are natural allies and we must work collaboratively to achieve our collective aspirations and continue to place our patients at the heart of everything we do in a supportive, empathetic, and empowering way. Essentially, we are on the same side and want the same thing; this should underpin all that we do.

As lockdown restrictions ease and the population looks forward in anticipation to some semblance of normality, our excitement is somewhat overshadowed by the threat of emerging COVID-19 variants. We should perhaps focus on creating a ‘new different’ as opposed to a ‘new normal’, proactively embracing the momentum of innovation that we have developed through the adversity of the pandemic.

It is our instinctive passion as GPs to care for our patients often at the expense of our own wellbeing. The lesson that the pandemic has taught most of us moving forwards is that we can’t always rely on the powers-that-be to implement systems to protect us from external pressures. We must, therefore, look after and protect ourselves to ensure we can enjoy our work and provide the highest standards of care for our patients.


Featured photo by Javier Allegue Barros on Unsplash

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