‘An Urgent Referral Still Takes Quite a Long Time’ (2019)

The Proper Gander column from the July 2019 issue of the Socialist Standard

If you have a medical problem and don’t mind your trip to the doctor being broadcast on the gogglebox, you’ve got a choice of where to go. If you’ve caught something gruesome or unusual, then the doctors on Embarrassing Bodies (Channel 4) will share your diagnosis with any voyeuristic viewers. Or you could register at one of the surgeries featured on Channel 5’s fly-on-the-consulting-room-wall documentary GPs Behind Closed Doors. The series isn’t cluttered up by narration or backstories (i.e. it’s fairly cheap to make), and instead just lets us watch what happens when people see their GP.

General Practitioners learn a lot about what makes us tick in their five years of training after spending up to six years in medical school. Those filmed for GPs Behind Closed Doors are all impressively knowledgeable and need to be, given the range of ailments people come in with. Patients are introduced with on-screen captions like ‘Pauline: Blistered Lips’ and ‘Regan: Nail Biting’. Other issues discussed include abdominal pains, memory loss, backache, weight gain and skin complaints. Some patients in the waiting room have completely fuzzed out faces, a presumably serious condition which we sadly don’t see the doctors address.

The GPs deal with their patients calmly and professionally, with empathy and kindness. But what’s really going on behind closed doors in NHS surgeries is a system in crisis. The UK’s population has grown by over two million in the last five years, with an increasing proportion of older people with complex health issues. The number of GPs and the resources of the health service as a whole haven’t grown to match, leading to ever-rising pressures on primary care services.

Many GPs have working weeks of around 50 hours, longer than is reasonable for anyone, but still not long enough to see every patient or get all their admin done. More than eight out of ten GPs believe their current workload is excessive or unmanageable, meaning they can’t be as thorough as they should (BMA Survey of GPs in England, November 2016). The constant slog to keep up means that 39 per cent of doctors report their morale as being low or very low (BMA Quarterly survey, quarter1, 2019).

GPs work long, stressful hours because there aren’t enough of them to meet demand. And there aren’t enough of them because the long, stressful hours put people off joining the profession. In 2017, over a quarter of Scotland’s GP practices had at least one vacancy, most of which had been unfilled for at least six months (BMA, June 2017). The number of GPs per 100,000 people has fallen from almost 65 in 2014 to 60 in 2018, according to a May 2019 study by the Nuffield Trust. The chair of the Royal College of General Practice, Professor Helen Stokes-Lampard, describes the situation as ‘gravely concerning’, adding ‘All GPs are overworked, many are stressed, and some are making themselves seriously ill working hours that are simply unsafe, for both themselves and their patients – it is making them want to leave the profession… This is having a serious impact on many of our patients, who are waiting longer and longer to secure a GP appointment. But it also means we don’t have the time we need with patients’.

Changes in demand should logically be met by increasing or reallocating resources to meet that demand. In capitalism, though, people’s needs are only met to the extent that it is affordable to do so. GPs are expensive: starting wages are over £57,000 a year, and the overall cost to the NHS for General Practice service providers was over £9,050 million in 2017/18. General practice accounts for just over 7 percent of NHS funding, with the proportion declining over recent years (www.pulsetoday.co.uk, Feb 2018). The lack of sufficient funding is largely down to how GP services don’t directly make a profit. General Practice is one of those institutions, like council housing, which the capitalist class would see as a financial burden, even though it helps knit society together. It benefits capitalism because it helps workers stay fit and healthy enough to be productive elsewhere, but as with everything else, costs have to be kept as low as possible so more money can end up with the elite.

Of particular interest to the capitalist class is how there is a lot of money to be made by producing the pills and potions we are prescribed. GlaxoSmithKline, Britain’s largest pharmaceutical company, makes profits of around £25 billion each year. Ill health can be lucrative, and one growth industry is mental health problems, which are discussed in around 40 percent of GP appointments. The number of prescriptions for antidepressants in England almost doubled over the past decade, from 36 million in 2008 to 70.9 million in 2018, according to NHS Digital. When a GP only has a few minutes with each patient, there may not be time to do much else than write out a prescription.

The pressures on General Practice, along with the rest of the NHS, mean that doctors just have to manage the best they can. It’s a credit to those we see on GPs Behind Closed Doors that they cope as well as they do.

Mike Foster