Earlier this week, the BBC's 'Panorama' revealed their findings that patients in a privately owned GP practice were struggling to get the care they needed. We decided to look at their findings and consider what alternatives are available to give you more choice in your medical care.
The Panorama programme on 13th June featured a report from journalist Jacqui Wakefield who worked undercover as a receptionist in a London GP practice owned and run by Operose Health. Operose is a private company that controls 70 GP practices throughout the UK, serving around 600,000 patients. This makes it the largest GP chain in the country. Panorama's investigation looked at various elements of the service provided by Operose Health, including the availability of appointments, patient care, staffing and document processing.
Appointments and patient care
The footage included references to days when reception staff could not book a single appointment. Ms Wakefield described feeling guilty as she received calls from patients crying in pain or who described having been unable to book appointments for around six months. She found that whilst a named GP supervised the practice, they were rarely on-site. One staff member said they hadn't seen the doctor for around six weeks as they managed several other practices. She was also criticised by other staff for telling patients that the lead GP wasn't in as they were 'technically' available on the phone.
The investigation also included conversations with patients who had experienced a reduced service since Operose had taken over. The number of full-time GPs had decreased, and it had become increasingly difficult to get an appointment. This included an elderly couple with ongoing health issues and a family whose young daughter's leukaemia diagnosis had been delayed. There was a lack of continuity of care as the family had spoken to a different doctor each time and been told that her symptoms were probably "normal".
Overuse of Practice Associates
The programme also found that the practice used Practice Associates (or PAs) in place of GPs. PAs typically have science degrees and receive two years of training to allow them to assist GPs. This contrasts with the ten years of training required to become a GP. Their hourly rate is less than half that of a trained GP. Whilst GPs interviewed during the programme said that PAs are a valuable part of the team as they can take a medical history and assist in the care and management of patients. They shouldn't be used as a substitute and need supervision from a GP every day, or ideally after every patient, but this wasn't happening. They said that there is an allocated period of 10 minutes a day to allow each PA to discuss the patients they'd seen with the lead GP; however, this rarely happened in practice. There is also a protected training period of half an hour each month which wasn't typically used.
Finally, the undercover reporter spoke to the admin team, who were tasked with processing patient correspondence and passing it to GPs. This was a separate central team tasked with sorting and actioning correspondence for 30 GP practices. Their role is to determine whether each document needs to be seen by a GP, a pharmacist or filed within a patient's medical records. The documents included patient's test results, medication change requests, and consultant treatment updates. They had a daily target of 200 documents each and needed to meet this, even when they were wary of making a mistake. They described having to make decisions using common sense and Google to research terminology they didn't understand.
Even when correspondence was passed on, this was not being dealt with by GPs, with some letters waiting for five to six months to be looked at. This included critical care cases, test results and documents relating to cancer patients.
The professional view
Panorama showed their footage to Professor Sir Sam Everington, a senior GP supervising a practice unconnected with Operose. He described his concerns for patient safety based on the evidence that was being presented. He said, "I'm quite horrified. You've got 20,000 patients and not a single doctor seeing patients? That's completely unsafe."
He confirmed that his practice uses PAs, but they would discuss each patient with him daily. He was concerned that the PAs at the practice shown were asking for supervision but weren't receiving it. He did not consider that you could adequately run and supervise a practice without being there and seeing patients yourself.
The delay in reviewing documents was also unacceptable. If test results or medication changes aren't acted on for six months, this creates a risk that a patient could develop a more severe illness or even die early as a result.
Operose Health's response
The BBC contacted Operose to present the investigation's findings. They commented that on the day when no appointments were available, five GPs had been working in the practice, however, they couldn't confirm whether any bookable appointments were available. Despite findings that Operose practices only employed 0.6 GPs per 2,000 patients, in contrast to an NHS average of 1.2 full-time GPs per 2,000 patients, they denied that the practice was understaffed. They describe having recruited an additional 38 GPs in the past 12 months and being in the process of recruiting 14 more. They say their use of PAs is in line with the NHS long-term plan, despite NHS figures showing that Operose employs six times as many PAs as the NHS average. Operose say that 97% of its practices have been rated either 'good' or 'outstanding' by the Care Quality Commission, and its document workflow processes have been commended. The CQC has indicated that they are taking these findings seriously and will investigate further.
The challenges facing the NHS
It's no secret that the NHS is under pressure. There's a general shortage of GPs and other medical and clinical staff. Waiting list data released in March 2022 showed that 62.4% of patients waiting to start treatment had waited more than 18 weeks, missing the NHS target, which aims to have 92% of patients seen within that time. Of 6.1 million patients waiting for treatment, over 300,000 had waited more than a year. The British Medical Association's analysis of the figures found that there had been a treatment backlog before the pandemic, which had only gotten worse. The analysis found that it had become more difficult for GPs to make referrals, meaning that they had to manage patient care whilst waiting for appointments to become available. Patient appointments at hospitals had decreased, and cancer targets continued to be missed.
There is also concern that a hidden backlog is growing, as people have avoided contacting their GP or had referrals cancelled. Of course, none of these figures shows how many people had tried and failed to get an appointment with their GP.
If you can afford it, perhaps it's time to consider using a private GP
If you've faced challenges in securing an appointment with your GP, it may not just be because of a lack of availability. GP surgeries are typically open during standard working hours, which may mean that you can't go and see your doctor because you've got to be at work yourself during those hours. However, some NHS GPs have been offering video consultations, and you can also pay for a private appointment on an ad hoc basis.
There is another option. Most private health insurers offer access to a 24/7 GP service where you can access a phone or video appointment at a time to suit you. Private GP insurance services will guide you through a series of questions, and the answers are then reviewed by a medical professional who'll contact you. This forms part of a broader package of private healthcare options, which could give you a quicker referral and the ability to bypass NHS waiting lists. It won't be the right choice for you if you have a complex medical condition or need management of an ongoing chronic disease. However, it could be ideal if you need quick advice and treatment for a straightforward illness and can afford it.
If you'd welcome the convenience of a 24/7 GP service that works around your work and family commitments, a private health insurance policy that includes private GP access could be the right choice for you.