As the dispute between junior doctors and the NHS continues to rumble on, we thought it would be a good idea to see how the action up to now has impacted on GP practices.
While it would be easy to say it will have little or no impact, as many primary care ‘leaders’ have done, from talking to practice managers it is clear that the strikes are really negatively affecting many practices. For example, one PM at a training practice – arguably those most affected – says that their practice is losing around 60 appointments every time its three trainees go on strike. That’s a fair amount of appointments for already stretched practices to make up – even when you take into account the fact that trainers will have a day without supervising anyone.
Not helping the situation is advice from NHS England, which suggests that where possible, people should contact their GP, seek advice from their local pharmacist, call NHS111 or consult the NHS Choices website.
However, GPC deputy chairman Dr Richard Vautrey told GPonline earlier this year that the strikes shouldn’t have a major impact. “Training practices should ensure trainees are supernumerary. There will be some appointments lost, but the trainer will have a day without having to supervise anyone.”
Dr Vautrey said that although a trainee may get through a similar number of appointments per day to a fully qualified GP towards the end of their training, this was likely to be largely balanced out by more junior trainees in the practice and appointment time lost to the GP trainer supervising them.
Following the strikes that have taken place so far, numerous practices are reporting a huge surge in the numbers of people trying to make appointments. This puts additional pressure on practices, a scenario that is even worse where walk-in clinics are offered.
“We’re really struggling to cope on strike days as we’re simply being overwhelmed by the volume of people,” one PM at a practice that has a walk-in centre told us. “While we’re dealing with the problem the best we can, it is having a negative impact on our patients and has led to a couple of really poor reviews. Those will live on long after the junior doctor dispute is resolved. I read the dismissive comments from the likes of the BMA and GPC who don’t seem to get how big an impact the strikes are having on primary care, and will continue to do so.”
With future strikes planned – there is scheduled to be a full withdrawal of labour between the hours of 8am and 5pm on Tuesday 26 and Wednesday 27 April – what can practices do to ease the situation?
Firstly, it’s worth reiterating Dr Vautrey’s point that, according to the terms of the framework for a written contract of employment for GP specialty trainees, GP trainees are supernumerary within the practice for the period of their placement. This means that the effective running of practices should not be dependent on the attendance of the GP trainee in the practice. Practices should take any steps necessary to ensure that their practice continues to run effectively in the absence of the trainee taking industrial action.
Then there’s communication, which is key, according to practice managers. One PM told us: “We’ve added notes to our website, printed simple flyers advising patients of upcoming strike dates and how it will affect services, and pinned notices on our noticeboard.”
Recommended communication includes reminding patients that you will be busier than normal and if there will be any direct impact on appointments, something that’s especially relevant at training practices. Make it clear that you will prioritise emergency patients on the day and try to contact patients in advance if their appointment needs to be rescheduled. To help matters, if possible try to avoid booking non-urgent GP appointments on the day of the strike and the day after. Also, if applicable, make it clear that non-medical queries such as sick notes, private letters and medical report queries will have to wait until the normal service has resumed.
Finally, it’s worth noting that the majority of the public supports the junior doctors at the moment, so make it clear in your communication why the strike action is happening and why it will help to protect GP services in the future. As practices feel the heat, anything you can do to win support from patients will be very welcome indeed.
Have you suffered from the knock-on effects of the strikes? What are your views on the situation? Let us know by commenting below or in forum here.