Findings from the thematic analysis
Qualitative analysis led to the identification of three key storylines in the media’s coverage of GP consulting and relevant policy changes:
the push for a return to in-person consultations;
policy changes and escalating conflict; and
(mis)representation and abuse of GPs.
The push for a return to in-person consultations
Many articles across both time periods drew attention to a need for better access to GP care and more in-person consultations. Various metaphors were used to emphasise depictions of in-person consultations as scarce in relation to demand. One journalist depicted GP appointments as being ‘like gold dust and face-to-face appointments even rarer’ (The Times, 24 October), another described in-person consultations as being ‘as rare as hen’s teeth’ (Daily Mail, 16 October), and a third suggested that ‘securing a face-to-face consultation feels like hitting the jackpot’ (Daily Mail, 14 October).
Two main arguments, illustrated by patient stories, were emphasised to justify the need for a return to in-person consulting. The first concerned the potential for widening health inequalities, primarily attributed to access disparities with remote-first GP care, particularly for patients who were older, had disabilities, or were homeless. According to one article, ‘vulnerable patients are struggling to get help, with some phoning more than 100 times a day to secure an appointment’ (The Telegraph, 13 May). This argument was supported by the story, widely circulated, of a daughter who called a GP surgery 286 times to book her 84-year-old mother an urgent eye appointment, only to be offered a phone consultation (Box 2, quote 1A).
The second argument concerned risk and safety in remote care, with articles focusing their narratives on missed symptoms and misdiagnosis. Concerns reported by the Royal College of General Practitioners (RCGP) that remote-first care ‘risks serious illnesses being missed’ (The Times, 13 May) were echoed by many journalists. Some articles took this stance further by suggesting that remote consulting may ‘have contributed to the death of some patients’ (The Independent, 14 October). To support this suggestion, two stories containing fatal outcomes appeared frequently. The story of the death of a 26-year-old from meningitis appeared in seven of the eight newspapers included in the current research. The articles reported that, during four remote consultations with GPs and nurses, in which the patient presented ‘with a range of escalating symptoms’ (The Independent, 18 October), none picked up his mastoiditis, which went on to cause a brain abscess. His father questioned the system (Box 2, quote 1B). The story of a 69-year-old also featured widely. Having been ‘refused’ in-person consultations, she was allegedly informed in a phone consultation that her leg and hip pain was arthritis; by the time she was diagnosed with cancer ‘it was too late for life-saving surgery’. The article argued that ‘cancer is often diagnosed after a GP has noticed subtle symptoms […] extremely difficult to pick up on a Zoom call’. It offered a fatalistic stance on remote care: ‘it wasn’t the [corona] virus that killed the former PE teacher three weeks ago, but the growing use of “telemedicine”’ (Express, 14 May).
No articles from either time period reported on positive patient experiences. Only one article offered a more nuanced view on when remote consultations may be appropriate and reminded the reader that they do happen for a wide range of people and conditions; however, as these conditions tend to be minor and the outcomes positive, ‘[we] do not hear of these stories in the media’ (The Guardian, 14 October) (Box 2, quote 1C). When articles pointed to the benefits of remote consulting in general practice, these tended to be limited to them being ‘a lot less of a faff than going to the surgery in person’ (The Telegraph, 15 October).
The media’s mobilisation of patient stories to reinforce their push for a return to in-person GP care seemed to be underpinned by a deterministic logic. At the start of the pandemic, the shift to remote care was widely considered a ‘perfectly sensible’ measure (Daily Mail, 14 October) ‘to protect patients and staff’ (The Times, 18 May) — the remote modality was thus depicted to a significant extent as causing safer care. Remote consulting — whether by phone, video, and/or email — was described as having the potential to save lives, but the wider context in which this could be realised (such as the significant work required by healthcare staff to enable a safe standard of remote care) was often overlooked by the press.8
An equally deterministic logic was adopted in 2021, but remote consulting was now depicted as causing safety incidents, and in-person appointments described as being the ones that ‘save lives’ (The Independent, 14 October), whereas other factors, such as long waiting lists in secondary care, and the need for additional tests and appointments to reach a diagnosis, were neglected. As the stories of patient experiences show, these deterministic narratives on remote consulting have also become fatalistic, with descriptions of the ‘harrowing consequences of diagnosis by phone, email or screen: symptoms missed, treatments delayed, lives ruined — and, too often, tragically lost’ (Daily Mail, 15 October).
Policy changes and escalating conflict
Negative patient stories were often mobilised in the context of extensive campaigns, particularly by The Telegraph and Daily Mail, calling for more in-person consultations — so vehemently that they led The Guardian to describe the newspapers as ‘on the warpath’ against remote consulting (The Guardian, 15 October). These campaigns played a key role in influencing the government to effect policy changes, which were widely praised by large portions of the media (Box 2, quote 2A).
When the May letter was published, only the right-leaning media (The Telegraph, The Times, Express, and Daily Mail) saw it as newsworthy and reported on it in the sample included in the current study. In addition to welcoming the policy change, The Telegraph used the opportunity to congratulate itself and its readers for their contribution towards it: ‘Congratulations, everyone! Well done us’ (The Telegraph, 19 May) (Box 3).
The Telegraph, 19 May 2021
‘Congratulations, everyone!
Well done us. All it took for NHS England to alter its guidance and tell GPs that they should offer patients face-to-face appointments was an immensely moving account from [reader] about the preventable death of his darling wife [name] , a couple of mortars fired by your columnist, Gunner Pearson, and several thousand emails of frustration, pain and disbelief from our magnificent Telegraph family. Plus, of course, a front-page scoop by Laura Donnelly and Rosa Silverman, which confirmed what we all suspected: doctors had been told to discourage patient appointments in person to promote digital consultations.
The swift U-turn was both an important victory for common sense — not seeing patients may well be “dangerous”, as so many medics pointed out — and proof that enough people acting together can push back against alienating measures which rob our society of the personal touch we treasure.’
Daily Mail, 14 October 2021
‘LAST month, the Mail launched an ambitious and important crusade.
Concerned so many readers and their loved ones were enduring the depressing ordeal of trying — and failing — to visit their family doctor, we delivered a powerful message to ministers: Let’s See GPs Face To Face.
Today, four weeks on, this paper is proud to record another stunning triumph. For Sajid Javid is unveiling sweeping healthcare reforms which should make it easier to get an appointment in person. In these pages, the Health Secretary and Prime Minister pay tribute to our important campaign highlighting this scandal.’ |
Box 3. The media’s influence on policy
The October directive was also praised in the right-leaning press. Like The Telegraph, Daily Mail congratulated itself for its contribution, describing the directive as ‘a major victory for the Daily Mail’s Let’s See GPs Face to Face campaign’ (Daily Mail, 14 October) (Box 3). The newspaper even ‘welcome[d] the threat to penalise surgeries financially for conducting too many digital consultations’ (Daily Mail, 14 October). In contrast, the left-leaning press was critical of the move, echoing GP concerns (below) around pressures facing general practice. One article went further, suggesting that it was ‘irresponsible’ for ‘Mr Javid to encourage the public to […] insist on their right to a particular service’, before describing the £250 million winter access fund a ‘slap in the face’ as insufficient to cover resourcing needs (The Guardian, 14 October).
The return to in-person consulting also generated conflict between GPs and policymakers. According to newspaper coverage, GP responses to the May 2021 letter were largely negative. It was reported that, although GPs welcomed the move away from an indefinite remote-first policy, they valued autonomy in deciding what was feasible and within capacity for optimal patient care. One of the articles described GPs as ‘angered’ by the letter and at NHS bosses for ‘adding fuel to falsehoods’ that surgeries were not offering in-person appointments (The Times, 15 May). Martin Marshall, RCGP chair, was quoted in several articles saying that ‘this is good news and is what patients and GPs want to see’ (Express, 15 May), but his support was more for ‘shared decision-making between GP and patient’ rather than a blanket return to in-person consultations (The Telegraph, 14 May). Only one article quoted the RCGP as describing the letter as ‘misjudged’ and ‘demoralising’ (Express, 20 May). Richard Vautrey, British Medical Association (BMA) GP committee chair, was quoted describing the letter as ‘completely tone deaf’, with the BMA reportedly calling on NHS bosses to ‘clarify’ how GPs were to meet patient demand (The Times, 15 May) (see Box 2, quote 2B).
GP responses to the October directive were reported in the media as almost exclusively negative. In addition to general criticism of the directive as a whole, such as Richard Vautrey’s description of the plan as a ‘shambles’ (Mirror, 20 October) from ‘a government completely out of touch with the scale of the crisis’ (The Guardian, 14 October) (Box 2, quote 2C), more specific criticism targeted the £250 million winter access fund. Although some GPs — like Graham Jackson, then co-chair of NHS Clinical Commissioners — described the investment as ‘a welcome starting point’, the consensus was that it would not ‘solve some of the longer-term workforce challenges’ (The Times, 14 October). They emphasised how the shortage of family doctors in the UK meant funding would not necessarily lead to recruitment as, according to one Shropshire GP, ‘there is no magic locum tree’ (Daily Mail, 15 October). They drew attention to more GPs retiring early or going part-time because of high stress levels and burnout, as well as fewer junior doctors training to become GPs (because of negative media coverage of the profession, see below) as key drivers of the GP shortage. The policy plan for league tables to ‘name and shame’ GP surgeries offering the fewest in-person consultations was also widely criticised. Although intended to increase the number of in-person appointments, GPs feared that the measures instead risked doing the opposite by adding to workloads and stress levels.
(Mis)representation and abuse of GPs
In the articles analysed there was mention of GPs traditionally viewed as ‘decent, dedicated and hard-working’ individuals (Daily Mail, 23 October) who ‘take great pride in making their communities healthier and happier’ (Daily Mail, 15 October). However, these views tended to be voiced primarily by members of the healthcare profession, such as by Chris Whitty, the government’s chief medical officer for England, who, speaking at the RCGP’s annual conference, described the work of GPs during the pandemic as ‘outstanding’, adding that he was ‘massively admiring of what you all have done, and continue to do, in the biggest public health challenge in our professional career’ (The Guardian, 14 October). Some journalists also praised GPs for their service during the pandemic, with descriptive terms including ‘outstanding’, ‘heroic’, or ‘marvellous’ (Daily Mail, 16 May; 23, 27 October). Notably, these positive representations were almost exclusively limited to individual doctors who invited their patients, reportedly without hesitation, for an in-person appointment.
More frequently, GPs as a collective were berated in the media. Negative narratives around GP access — particularly the difficulty in securing an in-person appointment, with many patients being offered a remote consultation instead — led to the perception that GPs are ‘lazy’ (The Guardian, 15 October), reluctant to work, and/or care little for their patients: ‘it just seems like GPs want to do as little as they can’ (The Telegraph, 14 October). These perceptions led one journalist to encourage GPs to ‘start doing what they’re paid to do — SEE patients’ (Express, 23 October). In the context of policy changes to encourage patient feedback (Box 1), one article commented on how patients would be asked to rate their appointment experience via text message, like they would ‘an Amazon or pizza delivery driver’ (Express, 17 October).
Whereas most of the criticism was in response to the use of remote consultations, some articles used the policy announcements as a platform to criticise GPs more generally. A common perception was that GPs are ‘a bunch of overpaid part-timers’ (Express, 16 October). The same article criticised GPs for struggling with their high workloads and blamed them for exacerbating the GP crisis: ‘I know there’s a GP shortage so why then are so many of them choosing to go part time? Why make a bad situation worse?’ (Box 2, quote 3A).
Ironically, one of the reasons GPs are choosing to go part-time or leave the profession entirely is what Marshall has described as ‘the widespread vilification of hard working GPs’ by ‘some politicians and sections of the media’ (The Independent, 14 October) (Box 2, quote 3B). By criticising portions of the media for their vehement, and unfounded, criticism of GPs, such comments serve to offset, or even reverse, their negative representations of family doctors. They also segue into concerns around the negative effects of the media’s ‘demoralising’ comments, which, according to Marshall, not only have ‘an impact on the mental health of GPs’, but have also led to ‘practice staff being on the receiving end of abuse’, both verbally and physically (Mirror, 14 October) (see Box 2, quote 3C). Some family doctors warned that the introduction of GP league tables would not only increase workloads and stress levels (as noted above), but also lead to an escalation of abuse.
The government, aware of this abuse, responded by including a ‘zero-tolerance’ campaign to tackle abuse and harassment of GPs in their plan (The Telegraph, 18 October). However, one GP suggested that ‘any further demonisation of general practice will perpetuate the problem we are trying to address’ (The Guardian, 14 October). As such, an end to the government and media’s denigration of general practice may negate the need for such a campaign in the first place — while also, perhaps, beginning to alleviate the ‘GP crisis’ by improving both morale and GP–patient relationships.
