A harsh spotlight

Life at Work
Tim Tonkin

GPs are prepared for just about anything that comes through their doors – but a politically motivated attempt to undermine the way they work has left them badly shaken. The Doctor continues its study of the pressures facing general practice

GP principal Farzana Hussain sometimes feels like she is part of a general practice tribe that is potentially facing extinction.

As the single-handed principal at the Project Surgery in Newham, east London, Dr Hussain has been a fixture within her local community for almost 20 years.

Nestled within a housing estate and adjacent to the path of the rails of the District and Hammersmith and City tube lines, the practice cares for a patient list of just 5,000, something Dr Hussain believes has allowed her to practise the type of family-doctor medicine she feels is becoming increasingly rare.

‘London is a young city and Newham is a young borough. Out of all my patients I’ve only got about 200 over 65 and I can honestly say that with at least 100 of them, I know what their front lounges look like, I know their children and their grandchildren. It’s really family medicine and that’s very satisfying for me.’

False narrative

The Project Surgery was originally founded via an urban regeneration fund new deal for communities.

Since 2013, the surgery has operated on a telephone-triage approach to consultations, something which allowed the practice to meet the challenges of COVID when the pandemic struck three years ago.

With the surgery opening at 8am, Dr Hussain and her colleagues, a locum and a salaried GP, received 65 incoming calls and manage 42 patient consultations between them on the day I visited, while also processing lab links, blood-test results and electronic prescriptions.

In the last five years it’s been really hard to recruit and since Covid I’ve really noticed the acute shortage of GPs

Dr Hussain

Indeed, just staying on top of and responding to the various emails arriving in the surgery’s inbox takes up at least an hour of Dr Hussain’s daily work schedule.

It is extremely frustrating therefore when she and her colleagues encounter accusations of GPs not being open and available in the press, among politicians and occasionally the public.

‘I think this whole narrative that the politicians and the papers have said about GP surgeries are closed, I think it’s been intentional,’ Dr Hussain says.

‘I think the public thought “oh, they closed the doors for COVID, but now we don’t have a pandemic, so GPs are just really lazy”.

‘The politicians certainly didn’t support us in countering this narrative. Indeed, at the end of the second wave they started talking about benchmarks for how many face-to-face consultations we should be having.’

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Patient relationships

In the course of a telephone clinic, Dr Hussain speaks to one of her rare, older patients, a man in his 80s set to undergo an MRI, about the medication he is using to manage his pain.

Greeting her like a family friend, he speaks enthusiastically of Dr Hussain’s recent TV appearance and how proud he is of her.

The closeness of the doctor/patient relationship is evident, yet Dr Hussain fears that part of the toxic narrative of GP surgeries not being accessible to patients is now being used to push a political agenda mandating increased levels of face-to-face appointments.

‘This government wants to push access but my concern with that is [in doing so] are we actually giving people safety and quality care?’ says Dr Hussain.

‘If one of my patients says, “I’ve got hip pain”, and I know that her husband died recently, I know that that’s going to impact on her pain thresholds. That’s something that you can know instantly, if you’ve got that continuous relationship.

In the next year, if this practice doesn’t merge, I think we will close

Dr Hussain

‘You can’t diagnose the cancer within five minutes, you need the time to ask questions and do a really good consultation.’

Added to the pressures driven by media headlines, the Project Surgery is also battling with an issue blighting every part of the health service, that of the struggle to recruit staff.

‘In the last five years it’s been really hard to recruit and since Covid I’ve really noticed the acute shortage of GPs,’ says Dr Hussain.

‘I’ve worked as a GP for 21 years and I’ve always had a full team, but in the last three years, I’ve lost my nursing team, my nurse, my full-time healthcare assistant.’

Fear for the future

It is no exaggeration to say that the Project surgery is at the heart of its community. From the clinical care it provides its 5,000 patients to being a warm space hub and providing foodbank services, to working with local football club West Ham United as part of a youth knife-crime reduction scheme.

Despite this, Dr Hussain fears for the future. The multitude of pressures being felt across general practice means that the surgery will likely have to merge with other local practices if it is to survive.

The politicians certainly didn’t support us in countering this narrative

Dr Hussain

In doing so however, Dr Hussain fears the continuity of care, family medicine approach she has always cherished will be lost.

‘In the next year, if this practice doesn’t merge, I think we will close,’ she says.

‘I’m personally very sad about merging and growing the list size, which is something I feel I need to do for financial reasons for the sustainability of the practice. But there won’t be that personal care, I think once you've gone to a list size of over 10,000 to 15,000 You simply can't have that anymore.’

‘I’m 50, and when I took my partnership at the age of 28, I would have wanted to stay on as a GP to at least 60 if not longer. Now, I can’t see myself being a partner further than 55.’