GP's stark warning: “Practices are going to fail”

Selkirk GP Rachel Mollart said: "Right now it feels like we are kind of fire-fighting".Selkirk GP Rachel Mollart said: "Right now it feels like we are kind of fire-fighting".
Selkirk GP Rachel Mollart said: "Right now it feels like we are kind of fire-fighting".
GPs in the Borders are ‘hanging on by their fingernails’ amid a stark warning that practices in the region could be forced to close due to increased pressures and staff recruitment challenges.

A Selkirk GP this week gave a graphic description of how she and her colleagues were ‘fire-fighting’ in response to spiralling workloads.

Dr Rachel Mollart, of Selkirk Medical Practice, was addressing a meeting of the Health & Social Care Integration Joint Board.

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She told members that GPs locally were finding it increasingly difficult to cope with patient pressures, the extra hours and responsibilities as she issued what she described as a ‘firework distress call’.

Delays in referrals are also placing the health of patients at risk, she warned.

Dr Mollart said: “Right now it feels like we are kind of fire-fighting, spending a lot of energy dealing with on-the-day stuff, additional work that is not pre-planned.

“When a patient comes in we are one of the practices that run a 15-minute model rather than a 10-minute appointment. It’s a blessing when a patient comes in with one thing, which is very, very rare now. When someone comes in and says ‘I’ve got this’, I’ll say ‘yes, but what else have you brought?’ and we’re so surprised when they say ‘nothing else, doctor’.

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“So patients are coming in with four or five complicated things to try and sort out in 15 minutes, so there is often a lot of follow-up from that.

“How do we feel? Generally workload is going up, some estimates say between 20 to 30 per cent on what we were pre-pandemic. We are also in the same position as everyone else trying to catch up on all the chronic disease management stuff that was temporarily put on hold during Covid.

“The stuff that we are seeing is more complicated, multiple problems and you can sprinkle on to that the impact that secondary care waiting lists are having, with patients coming in multiple times. We’ve seen someone, we’ve assessed them and we’ve passed them on, but then we’ve got this prolonged wait, so patients are coming back to us asking what is happening, saying they need more painkillers, stronger painkillers. These are repeat consultations that wouldn’t have happened in the past.

“There is also a significant concern in primary care around delays in urgent referrals, urgent requests for investigations. You have got patients who are actually quite sick, with a gut feeling that there is something serious going on. You request an urgent scan and that might take eight weeks to get, which is well beyond any cancer waiting lists and then there is delay in reporting that test, which might be another three or four weeks sometimes.

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“It means that patients when they are finally diagnosed may have a more advanced condition, with worse outcomes.

“Because there are such long waits we are doing a lot more quick-fixes, if you like. So we are emailing consultants, who are being incredibly helpful, but giving us advice for stuff that should really be happening in secondary care, so as primary care clinicians we are doing secondary care stuff, prescribing drugs that we wouldn’t normally, because we are trying to do the best for our patients, but it is risky and we might not be doing it as well as a secondary care consultant would, with maybe not the same checks and balances.”

Dr Mollart also warned that yet more challenges were coming down the line and predicted that further GP surgeries would be forced into closure – following on from the imminent demise of Chirnside Medical Practice in Berwickshire.

She added: “We have some challenges coming down the road. We have at least five or six practices that are going to have multiple GPs retiring, my own included. We have gone from seven GPs and we’ll soon be down to four. We can’t recruit so we are looking after the same number of patients, higher acuity, with more challenging problems with less doctors and ultimately there are going to be practices that are failing. We’ve already seen one handing its contract back at Duns, that’s going to be a recurring theme I think. Practices are going to fail and it’s going to be difficult to provide service to patients in the traditional model.

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“I think that GPs are hanging on by their fingernails and we’re fighting on every corner to try and stop work because we really can’t cope with what we’ve got. It’s not that we are being difficult it is that we are really worried about our resilience and our ability to carry on what we are doing. So I suppose it’s a big firework distress signal going up from primary care.”

Dr Mollart also outlined the typical GP working day, with early starts and late finishes, 8am to 6pm, with many doctors coming in even earlier to catch up with their workloads, and staying later, with it ‘very rare’ to be leaving at 6pm.

She added: “All of my colleagues are in about 7.30am trying to catch-up

“At our practice we have 12 patients in the morning, 12 in the afternoon, with lots of additional stuff added on to that, people squeezed in between, home visits to do. We are then fitting in additional house calls, people that have phoned in and we have nowhere to put them, who are not prepared to wait four or five weeks to see me, so they just leave doctors a message and ultimately that’s just another consultation as I end up having to phone that patient.

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“Then there is the non-patient facing work, all the documents, referrals, prescriptions.

“Then we have to take time out to run the business and to meet as partners to discuss the strategic and HR stuff.”

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