Greater Manchester GP Dr Helen Wall was at the heart of the fight against Covid-19 in Bolton, her hometown.
Dr Wall lived through the same anxieties and fears as many other families, as she took care of young children and an elderly father. But as the clinical director of commissioning for Bolton's NHS, and then the senior responsible officer for the borough's vaccine programme, the GP was always at the end of her phone, waiting to respond to the next Covid-19 development in the rapidly spiralling crisis.
Although Dr Wall says she has been left ‘knackered’ by her time as one of the leaders of Bolton's response to an unprecedented event, she continued in her role as a GP.
On the fifth anniversary of the first Covid-19 lockdown, Dr Wall has shared with the Manchester Evening News how the NHS still has not recovered.
In March 2020, as the Covid-19 pandemic was hitting, we were planning out ‘did we have enough PPE?’ ‘Did we have enough oxygen supply?’ ‘Did we have enough workforce?’ ‘Enough mortuary space?’
The things that we were talking about seem like something out of a film now. But after that, being a GP changed.
And, if I'm being completely honest, I don't think we'll ever get back to how things were.
Demand has gone up massively since Covid. People initially said ‘well, that's because GPs didn't do any work during Covid, they’re going to have a backlog’ – it’s not that.
Before Covid, the NHS already had a problem with demand versus capacity. It was then massively exacerbated by Covid. We've had a massive increase in our patients with mental health issues, whether that's low level stress, anxiety or significant mental health disorder. And we've got huge backlogs for operations, specialist referrals, and so much more.
People think that if there's a big waiting list in the hospital, it doesn't impact GP services. But if I, as a GP, refer anybody to hospital, our wait time is massively elevated compared to what it would have been pre-Covid. GPs are seeing people more than we did in terms of the number of appointments per patient per year. And we are managing a lot more conditions that we probably wouldn't have managed pre-Covid.
If you're on a waiting list for a hip operation, for example, and you previously would have waited three or four months – now you're waiting two years. In that time, you're going to need more GP appointments because you're going to need your pain relief checking, and you're going to come back and forth with escalating issues.
We would previously have just waited for patients to be seen in good time for their operation in hospital. But the backlog is so huge that it’s not really a viable option now.
When I think about the recovery of the NHS, for me, it's about how quickly we'll get back to reasonable waiting lists for people to be seen by specialists to have operations. That needs more funding to solve, and I think we're still probably at least two or three years off that.
But even then, things will never be the same as they were before Covid-19. The way people seek health care now is completely different.
In general practice, we'd already been asked to look into doing things like online consultations, text messaging and digital access before the pandemic began to help respond to increasing demand. When Covid hit and we were asked to close our doors, all of that just suddenly got expedited.
Now, to deal with the flood of conditions we’re treating following the pandemic, we've had to maintain some of those ways of working that we did in Covid to keep the doors open.
We still do face-to-face appointments, but we do a lot more telephone calls at patients' requests. We've found that some people prefer that because they don't have to take an afternoon off work to come to the practice, they can do it in their lunch break.
But as we’ve gone digital, we’ve become more accessible. By trying to fix the very problem that we were struggling to cope with – demand – we’ve increased it.
People contact us now for much more minor things than they would have done previously, because they can fill an online form in or they can do something digitally, reply to a text message.
We had online consultations during Covid and people would send us an online medical form at 3am and say they had a sore toe. Then when you would call them at 11am, they'd say, ‘well, it's better now. I forgot I even sent that in.’
The fact that people can ring us, have an appointment while they’re at work during the day means that they'll just get one just in case. Whereas before, they might have not taken an afternoon off work unless it was something that was really serious, or really bothering them.
It's Amazon Prime culture. You can, so you will.
Once people become used to a certain level of access and service, how do we ever go back from that? It’s like saying Amazon Prime finishes today and you're never going to be able to get your parcel the next day again. We have to get used to this new norm.
It definitely isn't the same job in that you don't have that same continuity with patients and that’s really sad. There's a sense that some people like the elderly can't get to us because we have less time as we deal with more minor ailments, or because they struggle with digital access.
That's why most of us went into general practice, because we enjoy being able to follow people through their life course and their ups and downs. When they're poorly and when they get better, when they have children and when the children are ill.
There’s been studies done to prove that people who have been to see the same GP do better in chronic disease, in long term long-term illness, in mental health. It definitely makes a difference to patients, to job satisfaction, and to the complaints we get.
Once you start removing that regular continuity of care, you've not got the same level of trust, rapport, communication, understanding – and our complaints go up.
It makes the job very difficult for clinicians, but also for receptionists because they bear the brunt of that.
Since Covid, we’ve struggled to recruit and retain admin and reception staff because of the level of anger and frustration that patients are demonstrating to them on a daily basis. I completely understand that frustration in most cases, but it feels like a difficult situation to fix.
It’s also increasing the number of GPs that have left, retired early, or are going abroad.
The number of GPs that are reducing their hours in general practice or doing other roles, that are using their qualifications to do other things is escalating year on year since Covid because, in large part, because the morale is so low, the job's got harder, and the job satisfaction has reduced.
And losing staff that you can't replace means it takes longer to answer the telephones, there are fewer appointments, people get more angry, and then it all just implodes.
The bottom line is there's only so many doctors, there's only so many appointments, and there's only so many hours in a day.
The stats speak for themselves. GP practices have more patient contact, more appointments a day than we ever have, including pre-Covid.
But we’re never on top of it and we feel like patients are never happy with the offer. So clearly something's not lining up right.
We've got a lot of people who are genuinely frustrated and fed up. They're fed up of waiting for everything, they're fed up with feeling like they're not getting access to what they need.
We get that – because we're all patients as well.
People think that because I'm a GP, my family and my children, myself, we don't access these services. We absolutely do. We treat each other, we don’t treat ourselves. And we don't get special treatment.
We get in the line and we ring up for that appointment at eight in the morning. We sit in A&E for hours on end, waiting to be seen. We see the other side of it and it's not great.
I don't think any of us would say that it's right. But attacking the staff, blaming the staff – it’s that saying… ‘don’t hate the players, hate the game’.
