My patient was already severely anaemic when she rang up saying she felt faint. You don’t have to be a medic to know that this is not a good sign, and for this (and other reasons) she needed urgent assessment at the hospital.
But the on-call consultant at the local hospital was not able to accept her – he couldn’t. “We’ve got no isolation rooms, an eight-hour wait and patients queuing outside the department,” he said.
It probably wasn’t his fault. In fact, I know it’s not, because I also know our hospitals are overwhelmed – how is he (or anybody else) meant to do their job properly?
Here’s a reality check: contrary to statements that the NHS “could” be overwhelmed by Omicron next month, I can say for a fact that it’s already happened. It’s here. We’re living through it.
But that doesn’t mean that it grinds to a halt. What it does mean is that doctors, nurses and other frontline healthcare workers are being forced to make more and more risky compromises.
I had another patient who waited hours overnight in A&E and never got seen. Another day, I called an ambulance for a baby who’d turned blue – it never came. Last week, my colleague had to keep a patient in the isolation room and monitor her all day – because the hospital couldn’t accept the referral.
And, last month, there was someone with an acute hip injury referred to orthopaedics who got a letter in the post with an appointment fixed up for next May – a six-month delay. I found it almost funny – I laughed. That’s because the patient with the acute hip injury was me.
These examples may not sound like very much, but to me, they are markedly out of the ordinary. This is not usual practice; I have never worked in circumstances like this before.
A patient told me last week that he had had “excellent” care in the hospital. I was so surprised that I responded with, “really?” It’s not that it’s a shock that people are still getting good care – but the infrastructure is not there when it comes to referrals. It is disorientating for GPs like me; general practice is not meant to function in isolation.
From my day-to-day experience, it’s not the people with Covid that are accounting for the huge workload but all the other people – the ones that haven’t been seen properly for the last 18 months.
Even now, during this current Covid surge, the inpatient data shows that the number of people in hospitals with Covid accounts for just 4.7 per cent of the beds available in England. The other 95.3 per cent of beds are occupied by non-Covid patients.
According to the data from NHS England, there were 4.13 million fewer elective procedures and 28.62 million fewer outpatient attendances than usual between April 2020 and October 2021. Right now, there are nearly nearly six million people on the waiting list for surgery.
If the doctor and nurse workforce literally doubled tomorrow, I think it would still take a full year to catch up – the real workforce to sort out this year’s work, and the fantasy one to deal with last year’s.
As well as the increase in the number of patients on the waiting list for surgery, we also all know that waiting times have increased. I’ve joined the more than 2 million people waiting over 18 weeks for an appointment, but there are 312,000 people who have waited more than 12 months – a 237-fold increase on the figures from before the pandemic started.
It’s hard to interpret waiting list figures and compare them to what’s normal. But when I know that I can’t reliably refer patients to A&E, that I can’t rely on an ambulance to come for a sick child or expect an acute injury to be seen for six months, it gives a sense of the reality of the healthcare all of us can expect right now.
“And what’s the answer?” a friend of a friend asked the other night, not interested in the details of my lived experience, but wanting to cut to the solution.
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I don’t know. Even in fantasy, I don’t have an answer. Don’t get sick?
I could say don’t come in with “silly” problems, but I think that’s what general practice is for, to help people resolve their worries about their health. So do come in with your problems to general practice – definitely.
Maybe advising everyone not to work too hard, not to eat too much and to walk at least an hour a day would help. Chat to friends. If everyone did this, it would cut down on loads of health issues and that would really help everyone. Easily said but hard to do. Save the NHS, anyone?
Dr Berenice Langdon is a GP and author of ‘Learning Microbiology through Clinical Consultation’