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GP shortages cause 'unacceptable' patient waits

Family doctors are under intense pressure and general practice is running on empty, warns the Royal College of GPs (RCGP). It says severe staff shortages are causing "unacceptable" delays for patients in England.

In a letter to Health Secretary Matt Hancock, its chairman says ministers must take urgent action to deal with the lack of GPs.

The government said it had recruited a "record number" of GP trainees. Ministers are committed to recruiting 6,000 more GPs in England by 2025.

Prof Martin Marshall, who took over as RCGP chairman in November, says GPs are struggling with an escalating workload, which is causing many to burn out and leave the profession.

Dr Andrew Dharman, who works at the The Avenue surgery in Ealing, said the stress has got worse because of the enormous workload placed on GPs. He said: "Sometimes it feels like you're drowning. You know you're trying to stay afloat and on top of all the workload. And you're trying to make sure you're providing the kind of care that you envisage when you go to medical school."

"You feel frustrated sometimes that you can't necessarily do that because of the amount of work and patients."

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Source: BBC News, 9 January 2020

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GP sexually abused 48 patients over 35 years

A doctor from North Lanarkshire has been found guilty of 54 sex offence charges against women over 35 years.

Krishna Singh, 72, kissed, groped, gave inappropriate examinations and made sleazy comments to 48 patients during appointments in various medical settings.

Prosecutors described how the sexual predator was "hiding in plain sight" over nearly four decades.

The offences mainly occurred at medical practices in North Lanarkshire, but also at a hospital accident and emergency department, a police station and during visits to patients' homes.

An investigation was launched into his behaviour when one woman reported him to authorities in 2018. A letter was then sent to all patients at the practice to see if they could help in the police inquiry.

Many women became so uncomfortable going to see the GP that they brought a friend or relative to appointments.

One woman tried to make her medication last longer to delay having to go back and see him.

Prosecutor Angela Gray told the jury during the trial that Singh had been in a routine of abusing his position to offend against women.

She said: "Sexual offending was part of his working life. Access to women as and when the situation arose and taking the chances when he could."

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Source: BBC News, 14 April 2022

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GP referrals system may be creating a 'hidden' patient backlog of patients needing treatment

A reduction in the number of GP referrals to hospitals could be creating a "hidden backlog" of patients needing help, according to a new report.

The study by the Institute for Government (IFG) and Public First says that not enough data is published about the "advice and guidance" referral system.

Family doctors have been told to reduce the number of people they refer for hospital care by using the 'advice and guidance' route – whereby a GP will call or email a hospital doctor to ask for advice on whether or not a referral is required.

The method has been used since 2015 but NHS England introduced a target for GPs to have 12 "advice and guidance" patients for every 100 outpatient appointments in October 2021 in an attempt to reduce the backlog of hospital care. This has now increased to 16 but it has been reported that as many as 22 out of 100 potential hospital appointments are being handled this way.

The IFG and Public First report states: "There is a risk that GPs making fewer referrals – in part to address hospital capacity concerns – is creating a 'hidden backlog' by allowing treatable conditions to deteriorate and possibly leading to more unplanned admissions."

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Source: Medscape, 14 June 2023

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GP receptionists will offer patients appointments at chemists, in bid to take pressure off family doctors

GPs’ receptionists will divert patients to see pharmacists in a bid to relieve pressure on family doctors. The NHS plan aims to prevent 20 million GP appointments, with many of those telephoning for help instead offered a "same day” slot at a local chemist. Health officials said the moves would mean more accessible and convenient access to services. But patients’ groups said the measures were “worrying”, with fears that critical decisions could end up being taken by those with little training in how to assess patients. 

From October, those calling 111 will be offered appointments at their local pharmacists if call handlers believe they are suffering from a minor ailment. Meanwhile, the NHS will pilot the same system for patients trying to make a GP appointment - with hopes to introduce the system nationally within nine months. 

Health Secretary Matt Hancock said the moves were similar to “the French model” where pharmacists have a stronger role providing healthcare. Officials said the plans may be extended still further, to divert patients attempting to seek help from Accident & Emergency departments. 

The changes are part of a five-year contract with pharmacists. 

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Source: The Telegraph, 22 July 2019

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GP practices training receptionists to do blood tests

A number of London GP practices are training their receptionists to do blood tests, Pulse has learned.

Professor Sir Sam Everington, a GP and chair of Tower Hamlets CCG, told Pulse that ‘lots of practices’ in the area have taken the step, including his own.

Training a receptionist to carry out blood tests – which can be done in just six weeks – provides much-needed support to pressured practices, he said.

Dr Everington told Pulse: ‘A lot of our receptionists have signed up to be phlebotomists and they love it because actually, phlebotomy is not just about taking blood. 

"You get to know all the patients with long-term conditions and so our phlebotomists know all these patients."

He added that reception teams are a ‘fertile recruitment ground’ for a phlebotomist. They can ‘manage even the most terrified patients’ and have ‘amazing’ clinical skills.

Dr Everington suggested that training receptionists as phlebotomists can help build trust with patients who are suspicious about having to describe their symptoms for triage by reception staff.

But he said that the extra role just ‘acknowledges’ that all members of practice staff are ‘part of the clinical team’.

He told Pulse: "In our practice, we all train together. We have meetings together, the whole team, and it’s acknowledging in this modern world that actually every member of your staff is a clinician – part of the clinical team – because there are always things they will do or can do that will have an impact clinically."

"There isn’t a hidden supply of GPs out there in the next few years. It takes 10 years to train GPs so actually help is going to come from a wider team base."

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Source: Pulse, 31 March 2022

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GP practice staff 'faced Islamophobic death threat' during riots

A GP practice was forced to shut its doors after a man threatened to kill a member of staff at the height of Islamophobic and racist rioting earlier this month, GPonline has learned.

The incident took place during the week beginning 5 August, according to British Islamic Medical Association president Dr Salman Waqar. He said he had heard from a fellow GP - who did not want to be named - that a man entered a practice, saw two members of staff, who are from ethnic minorities, and said: ‘I want to kill that Muslim man’. Police were called, the practice closed its doors for the day and staff worked from home. 

Dr Waqar, who is also a GP, told GPonline that "this kind of incident is obviously racist and it is very clear that it is Islamophobic". He warned that people working in general practice who are Muslim and from ethnic minorities - who may not have been personally on the receiving end of verbal and physical abuse during the riots - are still suffering from the psychological after-effects.

He said that most people were 'appalled and horrified' by the rioting seen in parts of the UK - but warned that there was a need to talk about the fact that these events had left people who are Muslim and from ethnic minorities second-guessing whether they were safe.

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Source: GPonline, 19 August 2024

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GP Patient Survey 2019

NHS England together with Ipsos MORI, have published the latest Official Statistics from the GP Patient Survey. The survey provides information on patients’ overall experience of primary care services and their overall experience of accessing these services.

Read results of the survey

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GP numbers in England down every year since 2015 pledge to raise them

The number of GPs in England has fallen every year since the government first pledged to increase the family doctor workforce by 5,000, a minister has admitted.

There were 29,364 full-time-equivalent GPs in post in September 2015, when the then health secretary, Jeremy Hunt, first promised to increase the total by 5,000 by 2020.

However, by September 2020 the number of family doctors had dropped to 27,939, a fall of 1,425, the health minister Maria Caulfield disclosed in a parliamentary answer. And it has fallen even further since then, to 27,920, she confirmed, citing NHS workforce data.

In the 2019 general election campaign, Boris Johnson replaced Hunt’s pledge with a new commitment to increase the number of GPs in England by 6,000 by 2024. However, Sajid Javid, the health secretary, admitted last November that this pledge was unlikely to be met because so many family doctors were retiring early.

Organisations representing GPs say their heavy workloads, rising expectations among patients, excess bureaucracy, a lack of other health professionals working alongside them in surgeries, and concern that overwork may lead to them making mistakes are prompting experienced family doctors to quit in order to improve their mental health and work-life balance.

The British Medical Association (BMA) said the figures Caulfield cited showed that the lack of doctors in general practice was “going from bad to worse for both GPs and patients”, and it warned that patients were paying the price in the form of long waits for an appointment.

“Despite repeated pledges from government to boost the workforce by thousands, it’s going completely the wrong way,” said Dr Kieran Sharrock, the deputy chair of the BMA’s GP committee. “As numbers fall, remaining GPs are forced to stretch themselves even more thinly, and this of course impacts access for patients and the safety of care provided.”

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Source: The Guardian, 11 April 2022

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GP mistakes led to patient suffering a stroke and going blind

Doctors missed a man’s stroke which led him to suffer another one and go temporarily blind.

The man said that the experience had changed him from ‘an outgoing social person, to a sheltered man living in fear that he is not being looked after competently’.

The 75-year-old visited his GP in Darlington complaining of dizziness, light-headedness, and a numb foot. 

He had experienced a stroke and should have been immediately sent to hospital. But doctors missed the signs, diagnosed him with a ‘dropped foot’ and requested an urgent MRI scan. However, due to an administrative error the referral wasn’t made and the scan never happened.

A month after visiting the GP, the man suffered a blinding headache and diminished vision. He saw an ophthalmologist who referred him to a specialist team.

He had suffered another stroke. He also paid for a private scan which confirmed the first stroke happened a month earlier.

Distressingly, the man lost vision in his right eye, which he was told could be permanent. Fortunately, his sight returned eight weeks later.

His daughter, who described the experience as ‘horrendous’, complained to the Parliamentary and Health Service Ombudsman (PHSO) about her father’s care.

The PHSO found that the initial symptoms were signs of a problem with nerve, spinal cord, or brain function. Doctors should have suspected a stroke and immediately sent him to hospital. If that had happened, the second stroke and sight loss would likely have been avoided.

Ombudsman Rob Behrens said:

“Having a stroke and then being told you could be permanently blind must have been incredibly frightening. The impact on the man, and his family who supported him through the ordeal, will have been deep and long-lasting.

“Mistakes like these need to be recognised and acted upon so that they are not repeated.”

Read full press release

Read case file

Source: PHSO, 4 October 2023

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GP Manish Shah jailed for 90 sex assaults on patients

A GP has been given three life sentences for 90 sex assaults on female patients.

Manish Shah assaulted 23 women and a 15-year-old girl while working in London - carrying out invasive examinations for his own gratification. The Old Bailey heard he used Angelina Jolie and Jade Goody as examples to frighten patients about their health.

Judge Anne Molyneux described him as a "master of deception who abused his position of power". "You made up stories which got into heads and caused panic," she said.

Shah, from Romford, convinced his victims to have unnecessary checks between May 2009 and June 2013.

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Source: BBC News, 7 February 2020

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GP Manish Shah guilty of sex assaults on 23 female patients

Manish Shah preyed on cancer concerns to carry out invasive intimate examinations for his own sexual gratification, the Old Bailey heard.

He convinced his victims to have unnecessary checks between May 2009 and June 2013. He was convicted of 25 counts of sexual assault and assault by penetration. Jurors acquitted 50-year-old Shah, of Romford, of five other charges.

They were told afterwards he had already been found guilty of similar allegations relating to 17 other women, bringing the total number of victims to 23.

Prosecutor Kate Bex QC told the trial: "He took advantage of his position to persuade women to have invasive vaginal examinations, breast examinations and rectal examinations when there was absolutely no medical need for them to be conducted."

The NHS in London said it "extended sympathies" to the victims and added: "As soon as the allegations came to light, swift action was taken and we have supported the police throughout their investigation."

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Source: BBC News, 11 December 2019

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GP leaders in England call for a pause in recruitment of physician associates

The BMA’s GP committee for England (GPC England) has called for an immediate pause in the recruitment of physician associates (PAs) in general practice.

In an emergency motion passed on 2 November the committee expressed “concerns over the increasing trend of PAs being used to substitute GPs” and called on practices and primary care networks to stop PA recruitment “until appropriately safe regulatory processes and structures are in place.”

GPs and GP registrars were also reminded that they can refuse to sign prescriptions and turn down requests for investigations made by PAs.

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Source: BMJ, 3 November 2023

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GP is struck off for “utterly deplorable” litany of treatment failures

A senior GP has been struck off the UK medical register for an “utterly deplorable” litany of treatment failures and for “reprehensible” professional conduct that included leaving patients in the care of unprepared trainee doctors and operating without adequate professional insurance.

At least two patients suffered “grave consequences” from inaction on the part of Surraiya Zia, including a man whose deteriorating condition was effectively ignored for six months, despite the fact that he “presented to Dr Zia frequently, sometimes up to three times within a week, with red flag symptoms,” said Samantha Gray, chairing the medical practitioners tribunal.

The patient was eventually persuaded to seek private magnetic resonance imaging by his family. This showed widespread stage IV lung cancer that took his life within weeks. 

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Source: BMJ, 21 April 2023

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GP industrial action may hit all services, ICBs and trusts warned

Integrated care boards and trusts should develop plans to deal with potential “whole system” impact of GP “collective action” from next week, NHS England has warned.  

In a letter to ICB and trust leaders this evening, NHSE asked systems to make a “best estimate” of the knock-on effects across urgent and emergency care, electives and discharge, and community and mental health.

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Source: HSJ, 22 July 2024

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GP given masks with expiry dates that have passed

A GP has criticised the practice of giving doctors surgical masks with expiry dates that have passed.

Dr Kate Jack said doctors felt "like cannon fodder" after discovering the paper masks had expired in 2016. A box delivered to her Nottingham surgery had a 2021 label placed over the original date of 2016.

The Department of Health and Social Care (DHSC) said equipment underwent "stringent tests" and was given a "new shelf-life" where appropriate.

"I don't feel protected at the moment," said Dr Jack, a GP of 22 years. "They are really not designed for prevention of infection and are practically useless."

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Source: BBC News, 25 March 2020

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GP contract strips out key cancer and mental health targets

Targets designed to improve mental health and cancer outcomes in primary care have been removed from the new GP contract agreed between the profession and government.

The 2025-26 general medical services contract sees core funding increased by £889m. GP leaders accepted the deal in principle following two months of intense negotiations.

However, the deal is contingent on the government confirming in writing by the middle of next month that it will negotiate a completely new contract within the current parliamentary term. 

The contract’s Quality and Outcomes Framework, which seeks to incentivise GPs to provide care in priority areas, has been radically reformed. 32 indicators which carried a total value of £298m have been removed. £198m of the total will be ”redistributed proportionately across nine CVD prevention indicators”. The remaining £101m will be reinvested into the global contract sum and in paying GPs to carry out routine childhood vaccinations instead.

Gone from the contract is the requirement for practices to hold dedicated registers of patients with cancer, chronic kidney disease, dementia, diabetes, learning disabilities, schizophrenia, asthma and COPD, as well as those receiving patient palliative care. The contract requires practices to keep accurate patient records, but no longer maintain dedicated registries.

Other abolished targets include tracking cancer care reviews, and the review of patients with depression and schizophrenia. 

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Source: HSJ, 28 February 2025

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GP calls for action after 125 of her care home patients die of COVID-19

“I am really angry about this,” said Dr Anna Down, scanning her computer for figures to show how coronavirus has ravaged her patients living in nursing homes.

“One home had 23 deaths, another lost 19, and another 13,” the Ealing GP said. “In two units 50% of residents died in the space of 10 days.”

Down is the clinical lead at a practice with 1,000 residents on its books in 15 privately run nursing homes in the area of west London hit harder than anywhere in Britain by COVID-19 deaths in the first weeks of the outbreak. In a normal month, she might expect to lose around 28 people. In the last month she has lost 125.

Down has a warning to the rest of the country informed by her practice’s experience: reform how social care handles Covid-19 or face rising deaths and a second devastating wave of infection.

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Source: The Guardian, 22 April 2020

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GP burnout: 'I was left feeling like a husk of a human'

The number of doctors seeking help for mental health issues has risen by more than three quarters within two years, according to figures from a specialist treatment service for NHS staff. For one GP, the relentless stress of the job led to him taking three months off work with burnout.

David Triska is no stranger to high-pressure situations. As an army medic, he served two tours of Afghanistan.

But mounting workloads at his village GP surgery left him feeling "hollowed out and spent". Simple tasks, like unlocking his car or making a meal, became a challenge - an experience he describes as leaving him feeling "like a husk of a human".

"At that extreme point, I couldn't see why I needed to be here anymore," Dr Triska said.

He is not alone. Since the year ending March 2021, there has been a 77% rise in the number of doctors seeking help for mental health issues, according to figures shared with the BBC by a confidential support service for NHS staff.

More than 5,600 doctors used the NHS Practitioner Health programme in England in 2022/23, with about a third having thought about taking their own lives.

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Source: BBC News, 5 October 2023

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GP ‘inconsistency’ compounding dangerous A&E crowding, says trust

A review into emergency care deaths at a struggling trust claims a “lack of consistency” in primary care referrals is a major factor causing A&E crowding.

Royal Cornwall Hospitals Trust, a national outlier for long accident and emergency waits and ambulance handover delays, carried out a review into potential harm to patients from crowding in its emergency departments, which has been obtained by HSJ.

The review found that several factors, both internal and external to the hospital, were leading to long A&E waits. Among them was a “lack of consistency in referrals from primary care”.

It said: “Too many GPs or their deputies send patients to ED when they could safely be referred to [inpatient] teams and bypass ED altogether.”

The review also found the ED was often being used by multiple specialties “as their receiving ‘ward’, bringing more patients to ED who do not need ED care”. This was particularly the case ”when [the specialty’s] own unit closes due to their opening hours, staffing or number of patients in department”.

Another factor was a “lack of provision of extended opening hours, staffing and radiology support for key [minor injury units and urgent treatment centres] meaning flow increases to ED in the evening”. The review also said there were “poor comms” when these services close.

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Source: HSJ, 21 November 2024

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Governments progress on negotiations for a pandemic agreement to boost global preparedness for future emergencies

Government-led negotiations on the world’s first agreement to protect people from future pandemics made significant progress during the latest round of discussions that ended today at the World Health Organization (WHO).

Substantive progress on the draft agreement, increased involvement of civil society and non-State actors, and a commitment by all parties to sustain momentum towards a  pandemic agreement were hallmarks of the 11th meeting of the Intergovernmental Negotiating Body (INB), which comprises the 194 member governments of WHO, and ran from 9-20 September in Geneva. Negotiators will resume discussions, at a 12th round, from 4-15 November.

Dr Tedros Adhanom Ghebreyesus, WHO Director-General, praised the “collective commitment” shown by governments and other stakeholders to conclude the pandemic agreement, and an urgent need to do so in light of the persistent threat shown by viruses with pandemic potential. 

“The next pandemic will not wait for us, whether from a flu virus like H5N1, another coronavirus, or another family of viruses we don’t yet know about,” Dr Tedros told the meeting. “But all the ingredients are in place to meet the objective of countries to negotiate a generational pandemic agreement. The world needs hope that it is still possible for countries to find common solutions to common problems. You can provide that hope.”

Ambassador Anne-Claire Amprou, INB Bureau Co-chair of France, said the latest round of negotiations demonstrated the commitment by governments towards a pandemic accord to make the world safer and healthier. It also showed the critical role being played by civil society and other non-governmental stakeholders to ensure that equity, innovation and collaboration are at the heart of the agreement.  

“During extensive discussions, visible commitment was shown by Member States of WHO towards a pandemic agreement,” Ambassador Amprou said. “There was clear recognition from all countries that we must agree on a way forward to work better, together, to protect their citizens from future pandemics.”
Ambassador Amprou added: “The constructive contributions by INB relevant stakeholders were incredibly valuable. Together, we must sustain this progress during the coming months to realize our shared goal to forge a pandemic agreement that guides future global responses to pandemics.”

Source: WHO, 20 September 2024

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Governments and corporations need to guarantee safety of COVID-19 whistleblowers

Over 90 civil society groups and individual signatories are calling on all public authorities and private sector organisations to protect those who expose harms, abuses and serious wrongdoing during the COVID-19 crisis.

Since the beginning of the COVID-19 emergency, worrying reports concerning hospitals and public authorities retaliating against healthcare professionals for speaking out about the realities of COVID-19 have emerged worldwide, from China to the United States.

Transparency International urges decision-makers at the highest level to resist the temptation to control the flow of information and instead offer assurances to individuals who witness corruption and wrongdoing to blow the whistle.

Marie Terracol, Whistleblowing Programme Coordinator at Transparency International said: “The need for transparency and integrity, heightened in this time of crisis where abuses can cost lives, illustrates the essential role of those who speak up in the public interest."

“National governments, public institutions and companies should listen to workers and citizens who come forward and report abuses they witness and protect them from retaliation, including in countries which still do not offer robust legal whistleblower protection. If people feel they can safely make a difference by speaking up, more instances of abuses will be prevented and addressed, and lives might be saved.”

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Source: Transparency International. 22 April 2020

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Government’s obesity campaign called out for being 'ineffective' and 'irresponsible'

The Government’s national obesity campaign risked turning fat-shaming into "wilful political strategy", said two humanities researchers in a new paper published in Sociology of Health and Illness. The Tackling Obesity campaign, launched by the Government "to improve health and protect the NHS during the COVID-19 pandemic", was "unproductive", "ineffective", "irresponsible", and could have led to "fat-shaming", they said. Moreover, the Government "perpetuated the neoliberal view that good health is essentially a matter of individual achievement earned through lifestyle choices and behaviour" - ignoring "the multiple structural and socioeconomic factors that contribute to obesity".

Co-authors Dr Tanisha Spratt, lecturer in sociology in the School of Humanities and Social Sciences at the University of Greenwich, London, and Luna Dolezal, associate professor in philosophy and medical humanities at the University of Exeter, said they were using the Tackling Obesity campaign "as an illustration" to explore "the dynamics between fat shaming, neoliberalism, ideological constructions of health and the 'obesity epidemic' within the UK".

They said that fat shaming was a practice that "encourages open disdain for those living with excess weight [and] operates as a moralising tool to regulate and manage those who are viewed as 'bad' citizens". They regarded this as an example of "how the ideological underpinnings of 'health' have been transformed under neoliberalism". Fat shaming discourses that are often used as tools to promote 'healthy' lifestyle choices are "problematic", they said.

Prof Dolezal, a principal investigator on the Wellcome-funded Shame and Medicine project, also co-authored a paper published earlier this month saying that the health and care system "should be more sensitive to people's 'shame'".

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Source: Medscape, 13 October 2022

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Government’s mental health review will not prevent ‘appalling’ abuse of patients, campaigners warn

A government review into mental health hospitals will fail to prevent the “appalling” treatment of patients, campaigners have warned.

The urgent inquiry into inpatient mental health services will focus solely on data, the government said on Tuesday.

The “rapid review”, launched following investigations by The Independent into “systemic abuse” across a group of children’s mental health hospitals, will last 12 weeks and is being led by a former national NHS mental health director Dr Geraldine Strathdee.

In an outline of what it will cover, the Department for Health and Social Care said it would look at what data is collected by the NHS on inpatient mental health services and whether it is used effectively to identify patient safety problems.

It will also look at the quality of data and identify good examples of care but it won’t look at individual cases of abuse or community services.

Major mental health charity Mind has warned the review “is not enough” and will not provide any learnings on how to prevent poor care. The charity is instead calling for a national statutory public inquiry into inpatient mental health services.

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Source: The Independent, 15 February 2023

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Government writes off £8.7bn of pandemic PPE

The government has written off £8.7bn it spent on protective equipment bought during the pandemic, accounts show.

The Department for Health and Social Care documents show items costing £673m were unusable, while £750m of equipment was not used before its expiry date.

The largest write-off - £4.7bn - was because the government paid more for it than it is currently worth, now that global supplies have recovered.

No 10 said the purchases were justified - with 97% of items suitable for use.

A further £2.6bn of equipment was judged to be unsuitable for use in the NHS, the 2020/21 accounts show, but the Department of Health and Social Care (DHSC) believes it could still be sold or given to charities.

At the start of the pandemic, countries around the world were clamouring for personal protective equipment (PPE), sending prices soaring.

No 10 said "we stand by the decision to purchase the items that we did", saying the approach was "justified" to get PPE to the front line. And the government was now able to "mitigate" similar problems in the future by "massively increasing our onshore-based PPE production".

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Source: BBC News, 1 February 2022

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Government works with TikTok to help safety for treatments abroad

Patients who use social media to help plan cosmetic procedures will now be able to access more reliable trustworthy information thanks to a landmark new initiative between the government and TikTok. 

More people are using social media apps like TikTok to research potentially risky operations - like hair transplants and dental work - abroad as they are often cheaper or more readily available than in the UK but are often presented with slick marketing campaigns that do not highlight the dangers of the surgery.  

To help keep these patients informed, TikTok and the government have partnered with medical influencers, like Midwife Marley and Doc Tally to create content to show the risks, help carry out thorough research and provides advice on how to make trips as safe as possible.

The Foreign Office will also provide more detailed travel advice for those seeking to travel abroad for ‘tweakments.’

Read full article.

Source: Department of Health and Social Care, 15 August 2025

Related reading: Crackdown on unsafe cosmetic procedures to protect the public

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