Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
Life & Times

The not so fortunate man: the changing face of general practice and public opinion

James Hibberd
British Journal of General Practice 2020; 70 (701): 600. DOI: https://doi.org/10.3399/bjgp20X713753
James Hibberd
North London; Workforce and Education Lead role, Islington GP Federation with responsibilities for care homes. Email:
Roles: GP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: james.hibberd@nhs.net
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading

The reputation of general practice, once seen as the ‘jewel in the crown’ of the NHS, is under threat. This has not been a sudden change but a slow deterioration over the last few years, further exacerbated by COVID-19.

The NHS has changed out of all recognition since its inception in 1948. The public has found these changes hard to accept in general practice and appears to be nostalgic of a bygone era when the GP was A Fortunate Man,1 a solo warrior against disease and injury available at all times of the day and night.

PUBLIC PERCEPTION

Public satisfaction with general practice has historically always been higher than other areas of the NHS. This started to change in 2017 when satisfaction dropped to 65%,2 the lowest level since the British Attitudes Survey began in 1983. In 2019, the same survey showed that 51% find it hard to get a GP appointment, suggesting access is an issue for many.

The recent COVID-19 crisis has made matters worse. The rapid closure of the doors of general practices, the initial shift of all COVID-19 care to 111, and the widespread adoption of telephone triage has angered patients. There has been a significant fall in face-to-face appointments since the start of the pandemic, with numbers dropping in England from 19 230 573 in February 2020 to 10 381 550 in August, a fall of 47%, with total number of appointments falling by a smaller but still significant 16.5%.3

The new reliance on telephone consultations and triage bring with them issues with continuity and communication. We know that there is something objectively different in a face-to-face consultation, which improves patient satisfaction4 by allowing crucial non-verbal communication including the therapeutic benefit of touch. Similarly, a loss of continuity of care not only reduces patient satisfaction but also seems to increase mortality.5

Public perceptions of the situation are not helped by the media portrayal of GPs, which was shown in a recent study to be overwhelmingly negative.6 It only takes a brief read of the message boards underneath articles about the recent letter to GPs from NHS England to see that the response is a significant feeling that GPs are either too lazy or scared to see patients.

Figure1

Image: National Cancer Institute on Unsplash.

Issues with public perception must be placed alongside the problems with morale in general practice. There is a reason A Fortunate Man does not have a happy ending and GPs have higher rates of mental illness then the general population. Low staffing numbers and increased bureaucracy have led to inevitable increased work levels, with a recent BMA survey showing that ‘... 79% of GPs are often or very often working beyond their regular hours — the highest of any branch of practice.’7

MANAGING CHANGE

The Royal College of General Practitioners has seen the COVID-19 pandemic and the changed ways of working as an opportunity to break this cycle, with a recent paper suggesting a post-COVID plan for a happy median of telephone and face-to-face appointments along with reduced administration tasks.8

Alongside this there was already movement towards increased use of allied healthcare professionals as part of the General Practice Forward View.9

With all of this in mind it is important that the necessary and inevitable changes in general practice are not seen by the public as a defensive measure, a way of keeping patients out and protecting GPs both physically (from COVID-19) and emotionally (from the stress of the job). While there may be a degree of the latter in our strategy, it must be ensured that the key tenants of easy access, continuity, and good communication are involved in our planning, with a view to both good care but also to improve patient satisfaction.

If we do not manage the current changes well and reverse the flow of public opinion we are in danger of destabilising general practice and, by extension, the NHS itself.

Footnotes

  • This article was first posted on BJGP Life on 20 October 2020; https://bjgplife.com/fortunate

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    1. Francis G
    (Feb 7, 2015) John Berger’s A Fortunate Man: a masterpiece of witness The Guardian, https://www.theguardian.com/books/2015/feb/07/john-sassall-country-doctor-a-fortunate-man-john-berger-jean-mohr (accessed 5 Nov 2020).
  2. 2.↵
    1. The King’s Fund
    (2018) Public satisfaction with GP services drops to lowest level in 35 years.
  3. 3.↵
    1. NHS Digital
    (August, 2020) Appointments in general practice, 2020, https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice/august-2020 (accessed 5 Nov 2020).
  4. 4.↵
    1. Hjortdahl P,
    2. Laerum E
    (1992) Continuity of care in general practice: effect on patient satisfaction. BMJ 304, 1287.
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Pereira Gray DJ,
    2. Sidaway-Lee K,
    3. White E,
    4. et al.
    (2018) Continuity of care with doctors — a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 8, 6, e021161.
    OpenUrlAbstract/FREE Full Text
  6. 6.↵
    1. Barry E,
    2. Greenhalgh T
    (2019) General practice in UK newspapers: an empirical analysis of over 400 articles. Br J Gen Pract, DOI: https://doi.org/10.3399/bjgp19X700757.
  7. 7.↵
    1. British Medical Assocation (BMA)
    (2020) Pressures in general practice. BMA.
  8. 8.↵
    1. Royal College of General Practitioners (RCGP)
    (2020) General practice in the post Covid world. Challenges and opportunities for general practice. RCGP.
  9. 9.↵
    1. NHS England
    (2016) General Practice Forward View, https://www.england.nhs.uk/gp/gpfv (accessed 5 Nov 2020).
View Abstract
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 70 (701)
British Journal of General Practice
Vol. 70, Issue 701
December 2020
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The not so fortunate man: the changing face of general practice and public opinion
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The not so fortunate man: the changing face of general practice and public opinion
James Hibberd
British Journal of General Practice 2020; 70 (701): 600. DOI: 10.3399/bjgp20X713753

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
The not so fortunate man: the changing face of general practice and public opinion
James Hibberd
British Journal of General Practice 2020; 70 (701): 600. DOI: 10.3399/bjgp20X713753
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • PUBLIC PERCEPTION
    • MANAGING CHANGE
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Ambivalent sexism within medicine: reflections from four medical students
  • Books: long read: The Doctor Who Fooled The World. Andrew Wakefield’s War On Vaccines
  • Lady Pereira Gray: an appreciation
Show more Life & Times

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242