The shutters are down, doors firmly locked. Laminated signs warn patients not to enter without an appointment.
In some cases, the lights have been switched off since March and the phones ring unanswered.
This is coronavirus Britain, where Mail on Sunday readers describe the difficulty of getting a GP appointment as being ‘like breaking into Fort Knox’.
Since our resident GP Dr Ellie Cannon first raised this issue a month ago, hundreds of readers have been in contact to complain that their local surgery has remained all but closed since the start of the pandemic – flying in the face of the official Government line that ‘the NHS is open for business’.
In March, family doctors had to swiftly adapt to new ways of working after the Government urged practices to increase the use of phone and video appointments – a vital step needed to reduce the spread of infection in waiting rooms during the first wave.
But fed-up patients have told us that, in some areas, even those appointments had become ‘a luxury’ and impossible to come by.
In March, family doctors had to swiftly adapt to new ways of working after the Government urged practices to increase the use of phone and video appointments – a vital step needed to reduce the spread of infection in waiting rooms during the first wave. Pictured: Stock image
Many have recounted heartbreaking, repeated attempts to reach family doctors to have serious or chronic health problems investigated, only to be told that face-to-face appointments are no longer available under any circumstances.
Significant numbers contacting us are either vulnerable or elderly, many have heart problems or diabetes and are struggling to get blood pressure checks.
Some are deaf and described the telephone appointments being offered as ‘next to useless’, while others simply can’t get through at all.
One reader described calling more than 100 times one morning before being placed in a queue, while being kept on hold for hours seems commonplace.
Little wonder many have stopped trying, despite having worrying symptoms.
Meanwhile, those desperate few who arrive at practices in person are ‘berated’ by reception staff, brusquely told to leave, barred from waiting rooms and made to wait in the ‘pouring rain’ on the street, in car parks, or under flimsy gazebos.
A 92-year-old was left standing in ‘bitterly cold wind’ because, she was told, offering her a chair would mean having to disinfect it afterwards.
Another elderly patient, who needs to lip read, turned up at her surgery to speak to a nurse who refused to remove her mask. She left ‘distressed and humiliated’. More than one frustrated reader despaired that ‘humanity has gone’.
Fed-up patients have told us that, in some areas, doctors appointments had become ‘a luxury’ and impossible to come by. Pictured: Stock image
The Mail on Sunday is today calling for this to end, for all GPs to offer face-to-face appointments to those who need them and to make sure that patients know they are available.
Dr Cannon said: ‘I’ve never had so many emails on a single subject – as a GP who is deeply committed to the NHS and my patients, it’s been distressing reading.
‘Most GPs are trying their best in difficult circumstances and all have a duty of care to their patients, but these harrowing stories make it clear that not all are fulfilling that duty. It’s not good enough.
‘Sometimes just seeing a GP is enough to reassure patients, but at other times it’s also necessary to diagnose concerning symptoms or monitor chronic conditions.
‘All GPs should make safe face-to-face appointments readily available if necessary – and, just as vital, make sure patients know how to have one if they need it.’
The despots at the front desk are back – and worse than ever
When Margaret Freeman tried to get a GP to carry out a home visit recently to her disabled, bed-bound husband she was ‘thwarted at every turn by an over-zealous receptionist’.
Mrs Freeman, 71, from Chadwell Heath, Essex, was told an appointment would be granted only if her husband Jim – who has progressive multiple sclerosis and cannot hold a phone – called himself at 8am.
‘It was callous and careless,’ Mrs Freeman said. ‘She either couldn’t – or wouldn’t – grasp that my husband can’t hold a telephone properly, let alone dial a number.
‘I emailed NHS England for advice as to whether or not a GP, even in these unprecedented times, has a duty of care to bed-bound patients. You know the answer – a resounding YES! NHS England were really helpful and kind, contacted the surgery and now they’re falling over themselves – too little, too late.
‘The manager asked me why I hadn’t contacted them directly, but one morning I rang 121 times before it even put me in a queue.
‘These receptionists think they can turn away sick people – who the hell do they think they are?’
Sadly, this is not an isolated experience. Readers’ emails have revealed many surgeries are using their receptionists to strictly triage patients and decide whether they even get a telephone appointment.
One described their receptionist as a ‘gatekeeper guard dog’ who ‘berated’ those coming near the surgery doors.
Marian Wille, who lives in a village on Anglesey, described how an 83-year-old patient was told by an optician that his blood pressure was dangerously high and that he should see a doctor immediately.
‘The receptionist told him he should go to Boots,’ she said.
Similar complaints about reception staff arose even before the pandemic.
NHS England spent £45 million on training so receptionists could direct patients to the best source of help or advice – an initiative designed to ‘free-up GP time’. But in some cases, patients complained they were being blocked from seeing their doctor as a result – a problem exacerbated by coronavirus.
Last week, Maureen Chamberlain, who previously worked as a hospital volunteer, wrote to us: ‘Reception staff with no medical training have taken over. It is down to their whim whether or not you can see a doctor.’
Irene Dakin from Hartley, Kent, described having to ‘run the gauntlet of the receptionist’ to get an appointment.
‘You get asked the ins and outs of everything but the kitchen sink, and if the receptionist doesn’t think you require a doctor you are not offered a telephone appointment.
‘Should you be lucky enough to be allowed an appointment you have no idea which doctor will call.’
Margaret Freeman said one receptionist admitted they were ‘still having training’. She said: ‘Receptionists must be taught to understand that people ringing up need help.’
Caroline Abrahams, chief executive of Age UK, has also backed our plea. The problems here disproportionately affect older people, who were the NHS’s ‘frequent flyers’, she said.
But some elderly people were also telling the charity they had ‘given up even trying’ to see their GP, which she described as ‘very concerning’.
The Office for National Statistics has since March been consistently reporting higher-than-normal numbers of deaths occurring at home – more than 1,000 extra a week, at present, than usual for this time of year.
Aside from the fact these deaths are not Covid cases, the causes remain unclear.
Abrahams said: ‘Most experts assume the higher-than-usual deaths at home are people who aren’t coming forward and getting treatment for things they normally would.
‘They should not be falling at the first hurdle by struggling to even speak to a GP receptionist – that is very worrying.
‘GPs must make sure patients know there is always an option for face-to-face appointments should that be needed.’
In a letter sent to GPs in September by Dr Nikki Kanani, NHS England’s medical director of primary care, practices were told not to tell patients that surgeries were closed or that face-to-face appointments were not available.
But many are not complying. Laurence Allen, a former NHS nurse from Kent, said: ‘Most living here will view surgeries as akin to Fort Knox – it is almost impossible to speak to a GP and as good as impossible to see one.’
And one doctor, who asked to remain anonymous, told us: ‘We discovered one surgery in our area has shut its doors and no one has been able to get an appointment at all.
‘I don’t know how – legally or morally – it could do so. Most patients I saw at an out-of-hours clinic were coming from that one practice, and said they couldn’t even get through on the phone.’
The tragedy is that many readers begin their letters with fulsome praise for their GP practices.
Many report they provided a ‘first-class service’ before the pandemic, that some continue to do so and that it is not all ‘doom and gloom’. Colin Garrod said his GP in Clacton-on-Sea, Essex, was ‘doing their very best in extremely trying conditions’.
This is, of course, to be applauded. GPs, like the rest of us, are operating in impossible, stressful times and face the same personal risks from the virus.
Many have faced staffing issues because of vulnerable or sick staff, or are vulnerable themselves.
For this reason, telephone and video appointments have been a success and are generally popular with patients.
Numbers of consultations across the UK are up by more than a million, year-on-year, according to the Royal College of GPs.
But Dr Gary Howsam, its vice-chairman, admitted: ‘Remote consultations will suit some patients better than others.’
If our readers’ worrying stories are anything to go by, this is something of an understatement.
Take the case of Angie Baker, 43, from Kettering, Northamptonshire. She has a two-year-old daughter and is the main carer for her elderly mother, Isobel, 71, who has an inherited lung condition and is classed as vulnerable.
Before this year, Angie says her surgery was ‘excellent’, with ‘kind and reliable’ doctors. But this year has been a ‘different story’.
Angie twice had to drive ten miles to an urgent treatment centre – once for an infected bite that needed antibiotics, and after passing blood – having been refused face-to-face appointments with her GP.
‘I was horrified,’ Angie says. ‘There was no way a doctor could tell over the phone if this was something sinister or not, and I told the receptionist I needed to actually see someone. She insisted it was not possible.
‘The clinic told me they had been inundated with patients who just cannot get in to see their local GPs. I
”m concerned for Mum and for my child. It seems patients just don’t have a choice or a voice any more.’
Others have similar tales. Yvonne Duncan, 67, from Buckhurst Hill, Essex, is sole carer to her husband Paul, 77, who is bed-bound with several complex illnesses.
He had a heart attack in June and Yvonne has chronic obstructive pulmonary disease and asthma.
Angie Baker, 43, from Kettering, Northamptonshire, twice had to drive ten miles to an urgent treatment centre – once for an infected bite that needed antibiotics, and after passing blood – having been refused face-to-face appointments with her GP
But since returning from hospital in July, the couple have had ‘no face-to-face GP or clinical support’.
‘We are unsupported, vulnerable, uncared for and at our wits’ end as to where to go for help,’ Yvonne says. ‘Should this life-or-death responsibility be my burden to hold alone?’
Pauline Settle, 74, from Buckinghamshire, said her ‘fit and active’ 74-year-old husband had developed hip, knee and groin pain but a doctor’s receptionist had directed him to a physiotherapist who emailed him some exercises.
‘I do not understand how they can make that diagnosis over the phone,’ she wrote. ‘My friend’s husband had the same symptoms and was dead in three months from cancer.’
Former nurse Pat Bailey, 67, from Worcestershire, who worked in the NHS for 45 years, said she had been unable to have steroid injections in her knees during the pandemic, usually provided by her GP, and had gone from ‘walking my grandchildren to school to hardly being able to walk at all’.
She cannot get an appointment. ‘What can I do?’ She concluded.
Meanwhile, Dawn Bourne, 57, from Leeds, who has progressive multiple sclerosis, was diagnosed with ‘dangerous’ hyponatremia – an abnormally low level of sodium in the blood – in January.
‘I’ve had no treatment and no chance of getting an appointment. It’s frustrating and upsetting,’ she said.
The Royal College of GPs say that, at present, just 45 per cent of appointments are held in person, compared with more than 81 per cent prior to the pandemic.
And the England-wide data hides huge variation by region.
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In the North East and Yorkshire, and the East of England, nearly two-thirds of all GP appointments are still held over the telephone.
Within the Midlands region, Leicester and Lincolnshire are back to providing most appointments face-to-face – 61 per cent and 65 per cent respectively – while in Northamptonshire it is 49 per cent.
The technology rolled out by practices during the pandemic to enable a switch to remote appointments has caused significant stress to many patients.
Those who’ve never used computers and the internet before, and don’t own smartphones, have struggled to complete the online forms many GPs now require to request an appointment.
Even those confident with technology complain the forms are difficult to understand, ask irrelevant questions (one asked about recent betting habits) and ‘took three days to complete’.
Several people who have hearing problems reported effectively being ‘shut out’ of their GP surgeries because they could not attend in person.
Annette Pollock, 78, who is deaf, said she ‘found it frightening’ that she cannot get an appointment with her GP without first having a telephone consultation, which for her is ‘useless’.
But despite all this, most GPs are actively trying to protect their patients from the virus.
It’s individual practices that decide whether or not they can safely see patients in their surgeries.
Dr Helen Tattersfield, who runs a GP practice in Bromley, Kent, does share patients’ frustrations, and says: ‘Physical contact is what makes life work. It’s not the job we signed up for. It’s like being a call-centre worker rather than a GP.
‘When patients walk through the door you have a pretty good idea of whether someone is OK or not – which, on the phone, is not as easy.
‘You’re concerned you might miss something. You think, is that baby really OK? It’s harder to pick up on domestic violence.
‘If there’s any doubt at all, we’ll see them in person. But you feel you’re not doing the job as well as you’d like to, and you worry about patients you’re not seeing.’
And while Dr Tattersfield acknowledged not every GP was providing a good service to patients, she added: ‘Having NHS England write to us reminding us to do what we’re already doing doesn’t do wonders for morale. Is anyone actually looking after us here?’