Doctors and their staff working in GP surgeries across England are reporting a torrent of abuse from patients, with some receiving hate mail while others have been left shaking and in tears by physical and verbal attacks.
Some family doctors have told The Independent they fear coming to work, and have seen staff quit over the threats they are receiving almost daily.
Some surgeries have been subjected to bomb threats, while others have been daubed with graffiti. Staff at one practice in London have received hate mail threatening workers over their role in the Covid vaccination rollout. Other were sent abusive text messages describing staff as “Nazi b*****ds”.
GPs say the majority of problems are being caused by the system being overwhelmed with demand, and a false perception among some patients that GPs are closed and seeing fewer patients in the wake of the Covid crisis.
Delays in being able to get appointments due to a workforce crisis in GP numbers and surges in patients wanting to see doctors means that some patients are having to wait weeks for non-urgent appointments.
But GPs are facing a relentless workload, with many on duty for long hours, dealing with increasingly complex cases and more administration, as rising numbers of patients left waiting for hospital treatment because of growing NHS backlogs turn to their GPs for support.
A recent survey by the British Medical Association found that half of doctors, and two-thirds of GPs, had seen colleagues experience violence or abuse.
One GP practice in London has reported hate mail it received to the police, after staff received multiple photocopies of a notice telling doctors and nurses they would be “put on trial for war crimes and held accountable”.
Watch: People urged to see GP in cancer campaign
The practice said: “This was photocopied numerous times, and put in envelopes, and individually addressed to each of our clinicians, and posted through the door after dark.
“We have had a number of abusive responses on text, via email, by phone and in person as we try and keep all patients updated.”
It’s not a day ending in ‘y’ unless somebody is reduced to tears by a patient. It’s making it very difficult to retain staffDr Emily Ball, GP
The Independent has spoken with GPs working in surgeries across England who fear the increasing levels of anger they are seeing from the public will drive more GPs to quit their jobs, deepening the crisis already facing primary care.
Dr Emily Ball, a GP working in Liverpool and a member of the EveryDoctor group, said she had been left shaking and tearful after a tirade of abuse from a patient angry at delays to his hospital appointments.
In another incident earlier in the year, police had to be called when a man demanding antibiotics physically forced his way into the practice and followed staff while verbally abusing them. The man was not even a patient at the practice.
Dr Ball said: “We did have to call the police. It was frightening and that member of staff has unsurprisingly left now.
“It’s the more insidious daily verbal abuse that’s a real problem, and it’s led to staff going off sick. It’s not a day ending in ‘y’ unless somebody is reduced to tears by a patient. It’s making it very difficult to retain staff.”
She is supposed to work 31 hours a week but has calculated she is currently doing an average of 65 hours a week.
“We are on our knees. Yet there is this perception that we have stopped seeing patients face to face and we haven’t. We have seen people who have needed to be seen, all the way along.”
Describing her own experience of abuse from an angry patient, she said: “He told me that I was ‘fucking useless’, that I shouldn't be practising, and it was a disgrace that we didn’t care about our patients. Several times he said he thought I should be reported to the GMC. I was physically shaking after.”
Dr Ball, a GP of 14 years, warned the longer-term impact was going to worsen the existing crisis for GPs as their numbers have failed to keep pace with the rise in population and demand.
“When you’ve got an already demoralised workforce, and then they start getting kicked by the very people they are literally killing themselves trying to help, what happens is that people start burning out, they start going off sick; and that means that there’s more pressure on the doctors who are left, so they burn out, they go off sick, and before you know it you’re not going to have a workforce.”
A survey of more than 330 GP practices across London in June found more than half said the current demand on them was unmanageable, with 82 per cent warning it was affecting staff wellbeing. Four-fifths of practices said patient satisfaction was being hit.
Almost half of practices had vacancies for GPs, with some practices forced to consider closing their doors – a move that would hit 22,500 patients.
Birmingham GP Lizzie Croton, a member of the Doctors’ Association, said there were now more ways for patients to contact GPs via digital services, which she said meant more “cognitive load” on doctors.
“We’re experiencing increasing amounts of demand from patients. All the people that I see believe that they need to see us, and they’re in some sort of distress.
“Our doors are wide open electronically and also physically, but every contact generates workload. I am working an extra couple of hours every day and I rarely have a lunch break.
“There have always been waits in the NHS, but what’s different at the moment is that people are not being given dates, or if they are it’s months away. We’ve had verbal abuse, especially the reception and admin staff, mainly because of waits. Most of the time it’s very understandable and you share the patients’ frustration, but we have had some where it has been personal.
“People are less tolerant about having to wait to speak to someone.”
As well as frustration over waiting times and patients demanding faster appointments, GPs have also been on the frontline of a backlash against the Covid crisis and vaccination schemes.
One GP in London described how a patient who had been sent a vaccination reminder letter “barged” into a back office and began shouting at staff.
They said: “The man was aggressive enough that we called 999 – shouting, swearing, getting very close and ‘squaring up’ to us. He filmed part of the incident, despite our requests for him not to, and the video later found its way onto Twitter.
“This is just the worst of a number of incidents. We have had reception staff in tears several times in the last few weeks because patients or relatives have been so unpleasant.”
Watch: NHS doctor and former refugee says Afghans must be treated humanely in the UK
Many GP practices have been told by the NHS to send out text messages and reminders to residents to encourage them to get vaccinated.
The Independent has been shown multiple examples of aggressive and rude messages sent to surgeries in response.
Dr Michelle Drage, chief executive of Londonwide Local Medical Committees, said: “NHS England and the government need to get the message out at a national level that general practice is working as hard as it can, and those on the other side of the reception desk, the consulting room or at the end of the phone are people, not a faceless sounding-board for frustrations.
“London practice staff are receiving profanity-filled text messages in response to vaccination reminders, and those making calls are getting abuse and threatened with being reported to regulators, all just for doing as instructed by the NHS. Even those people who are merely hesitant about vaccinations have been known to become abusive after repeated contacts.”
The Royal College of General Practitioners (RCGP) said there was a serious misconception about the work being done by GPs, who were still seeing patients when needed. He said practices were busier than ever while simultaneously delivering two-thirds of all Covid vaccinations.
Professor Martin Marshall, chair of the RCGP, said: “It’s entirely unacceptable for anyone working in general practice to be at the receiving end of abuse of any kind, let alone the threat of physical violence.
“General practice has been open throughout the pandemic, and face-to-face appointments have been offered wherever safe and appropriate.
“The real issue is that we have a huge shortage of GPs, and our workforce is not big enough to manage the needs of an ageing and growing patient population with increasingly complex needs. This was the case before the pandemic and it has only been further exacerbated by the events of the past year.”
He said it was vital that the government deliver on its pledge of an extra 6,000 GPs by 2024.