The GP surgery in the coastal village of Hightown, on the banks of the Mersey estuary, is a short stroll from the High Street.
Based in a red-brick converted shop, it sits in the heart of this close-knit community of more than 2,000 people (geographically, at least), many of whom are elderly.
Five doctors are listed on the ‘our staff’ section of the practice website.
But for long periods of the week, the only person in the once thriving and popular surgery is . . . the receptionist.
Those five doctors? They are actually based at another surgery in another town, a ‘parent surgery’ in nearby Formby, and only one of them is ever in Hightown.
Even then it’s only on a part-time basis — the reason being that there simply aren’t enough GPs available to fully staff both practices, five days a week. The husband-and-wife doctor team who had run the practice for a generation retired some years ago, and things have never really been the same since.
‘What’s the use of a GP’s surgery without a GP?’ asked one resident, a question almost everyone in the village has asked themselves.
Overall, GPs are allowing 3.4 million fewer face-to-face consultations per month compared with before the pandemic [File photo]
Hightown is in the metropolitan borough of Sefton, north of Liverpool, which just happens to be the most challenging place in the country to live if you want to see your GP.
Just 44.8 per cent of patients had face-to-face consultations between the start of January and the middle of last month, less than anywhere else. In 25 other areas, the figure is also less than 50 per cent, according to data from the House of Commons library, made public this week.
Overall, GPs are allowing 3.4 million fewer face-to-face consultations per month compared with before the pandemic. Yet, few places could have experienced the brunt of the GP crisis more than Hightown.
On Wednesday, when we rang the surgery, the receptionist — who did not inquire about the reason for our call — said there were no appointments and told us to phone back in the morning.
One alternative option is to click the eConsult ‘button’ on the surgery website. This NHS app, used widely throughout Britain, involves uploading your passport or driving licence to register, and then completing an online form with details of your symptoms.
This information is then forwarded to your GP, who will examine you via a video link, known as digital triage, to decide what course of action should be taken.
Many elderly people, not only in Hightown, are unable navigate so-called ‘Zoom medicine’.
Another option is to travel to Formby, more than three miles away, where the parent surgery is located in Chapel Lane.
There isn’t a direct bus route from Hightown to Chapel Lane, however, and the surgery is a ten-minute walk from the train station in Formby and not everyone in Hightown has a car.
The corollary to all this is that an increasing number of residents in Hightown who need to see a doctor are going to the village pharmacy instead. The pharmacist, Ellis Hall-Lyon, has now become the de facto GP, and his consulting room a de facto surgery.
Pharmacists are highly trained health professionals who can provide expert advice, repeat prescriptions and treatment for many common complaints such as headaches, upset stomachs and minor rashes, freeing up doctors for more complex work.
But Mr Hall-Lyon, 48 — with help from his wife, Fleur, 47, and two ‘dispensers’, Sylvia Williams and Tom Sinclair — has been dealing with all manner of serious conditions and emergencies.
He has patched up people involved in cycling accidents, people with lacerations, people who need their stitches and dressings changed, and those requiring urine tests, which are carried out on the premises.
Mr Hall-Lyon also treated someone who had suffered a deep facial wound after cutting himself with a grinder and, on another occasion, a pensioner complaining of feeling dizzy who turned out to be in the throes of a life-threatening heart condition.
Many elderly people, not only in Hightown, are unable navigate so-called ‘Zoom medicine’. Another option is to travel to Formby, more than three miles away, where the parent surgery is located in Chapel Lane
Both cases resulted in an ambulance being called.
Almost every other day, the unwell and the walking wounded are turning up to see Mr Hall-Lyon — not a GP.
‘I cannot say how many people are being seen by a GP in Hightown, but it seems to be fairly low, judging by the amount of people who are coming to the pharmacy,’ said the tireless Mr Hall-Lyon.
‘If you do not ring at 8am and get those handful of appointments, you are told to ring back the following morning.
‘Some want help straight away, which is why they come to us.
‘Pharmacists are only trained to a certain level. We need GPs to start mucking in again.’
There is little doubt that illnesses are going unspotted and patients are dying. Such was the fate of retired taxi driver Peter King from Brentwood, Essex, according to his widow, Lisa. His death was highlighted on Jeremy Vine’s Channel 5 show this week.
Lisa had asked for a face-to-face appointment after Peter complained of stomach pains. He was diagnosed with acid reflux over the phone and prescribed medication. Shortly afterwards, he had to be taken to hospital when a gallstone was discovered in his bile duct.
Mr King was discharged following surgery, but the delay in treatment culminated in a severe infection and he died four weeks later.
‘You can’t diagnose something like that over the phone,’ Lisa said. ‘He passed away and it was all a result of not seeing the GP.’
Then there was another caller to the show, Nick from Northamptonshire, who tearfully described how he’d repeatedly been refused in-person appointments despite concerns over a mole on his back. When he was finally seen, he learned that, due to delays, he has inoperable cancer and just 12 months to live.
Sadly, the public perception of GPs is that they are overpaid — the average GP wage now tops £100,000 — and underworked, dragging their feet in getting back to the surgery to resume a normal service.
The Patients Association chief executive Rachel Power says: ‘The figures for face-to-face GP appointments have remained steady at around 50 per cent for a year. This is better than at the height of the lockdowns, but we know many patients would prefer to see their GPs face-to-face.
‘Some are happy with telephone consultations and will continue to consult with their GPs this way, and for others being signposted to a pharmacist may be satisfactory.
‘But for many patients, neither of these options is satisfactory.’
That view is echoed by Age UK: ‘Any older person who needs a face-to-face appointment should get one,’ says Caroline Abrahams, charity director. But isn’t the truth more complicated?
‘The reason you’re finding it difficult to get an appointment with a GP isn’t because we are lazy, workshy, scared of catching Covid, refusing face-to-face appointments, or any other of the b******t reasons,’ one doctor tweeted recently.
‘The reason is . . . there are too few GPs, primary care nurses and the funding doesn’t go far enough.’
One practice, the Waterfront and Solent Surgery in Hythe, near Southampton, revealed on Facebook that on August 6 more than 900 incoming calls had been received by 8.18am, which staff described as ‘a usual morning in General Practice’. Repeat: more than 900 calls.
Across England, 60.8 million patients were registered at 6,571 practices in June, equating to an average 9,258 people per practice, up 2.4 per cent on the year previously — the highest figure since comparable quarterly records began six years ago.
At the same time, NHS figures show that the number of fully qualified GPs fell by 4.5 per cent between September 2015 and March 2021, which means the UK now has the second lowest number of doctors in leading European nations relative to its population, after Poland.
The vaccine rollout, say doctors’ groups, on top of their normal responsibilities has resulted in a burned out and disillusioned GP workforce — and angry patients.
A survey by the British Medical Association found that 37 per cent of doctors had been verbally abused by patients, or those accompanying them, in the month of July as a result of the pandemic. The upshot is that the Royal College of General Practitioners expects many GPs (as many as a third, in fact) to quit the profession within five years, largely over stress.
There will be a predicted shortfall of 7,000 GPs by 2023, say the RCGP, unless more are recruited — as per the Government’s 2019 pledge. The reality, though, is that fewer people want to go into general practice and many that do want to work part-time, which is not necessarily in the best interests of patients.
The majority of GPs are women, however, and flexible working patterns have helped recruit and retain them by allowing them to balance the job with family life. This is the other side of the argument, one often lost in headlines. None of this will come as consolation, however, to the people of Hightown and thousands of other patients across the country who can’t see a doctor.
A number of different GP groups, including one that had its contract withdrawn following an ‘inadequate’ rating from the Care Quality Commission, ran the practice after popular GPs Judith and Geoff Welch retired; the present incumbents took over in 2018.
‘I am absolutely sure Hightown residents are not going to suffer as a consequence of a takeover,’ Dr Kati Scholtz, clinical director of the local Care Commissioning Group (CCG), assured residents. When she and fellow NHS executives were grilled by Sefton councillors recently, they insisted residents would have ‘access’ to a GP at all times — before admitting that the doctor might not be physically present.
Other surgeries in the area are facing similar challenges.
The South Sefton CCG, the body responsible for hospital and community NHS services in the area, was bottom of the league table for face-to-face GP consultations (44.8 per cent) in the latest set of figures mentioned earlier.
Before the Covid-19 crisis, 80 per cent of consultations with a family doctor in England took place in person.
The statistics don’t necessarily present the full picture: GP practices still had to observe social distancing after July 19, when the rules were relaxed for other settings — a largely unreported fact.
That created particular problems in Sefton, where most surgeries are not purpose-built health centres but converted houses with small receptions and poor ventilation.
‘This significantly limits the number of patients we are able to see face-to-face in a Covid-secure manner,’ said Dr David Smith, chair of the Sefton Local Medical Committee. ‘Remote consultations are the only way we can possibly access and treat as many patients as we did before the pandemic.’
Sefton itself spans 22 miles of the Merseyside coastline, with a mix of affluent and deprived areas. Overall, levels of long-term health conditions are much higher than national averages and, combined with an ageing population, has put pressure on health services.
New research from the University of Cambridge found there were on average fewer GPs per patient in poorer parts of England than wealthier regions.
The plight of people like Barbara Thomas, 61, doesn’t usually make the papers. But her experience — the sheer exasperation of trying to see a doctor — will strike a chord with many.
Ex-florist Barbara lives in the Sefton area, and needs to see her GP for myriad conditions, including diabetes.
‘You ring when the surgery opens at 8am and the phone is constantly engaged,’ she says.
‘When it does connect, you can count the 40 rings until a voice will tell you to try again. I sometimes carry on like that for an hour. I can’t hold the phone for long because my hands go numb. I have to put it down.’
Her surgery, which she has asked us not to name, has just one doctor. She says that for non-urgent appointments she faces a three-week wait to be seen.
‘Dreadful’ is the word she uses.
Back in Hightown, Jacqueline Warham, who runs the village shop, reveals: ‘One man sent the surgery a photograph of a rash and was told it was nothing to worry about. Then it was diagnosed as skin cancer. It’s shocking.’
A number of questions about the issues raised in this article were emailed to the surgery, but at the time of writing, it had not replied.
In some cases, a quick phone or video consultation may be beneficial and more convenient.
In July, 14.6 million GP appointments (57 per cent) were face-to-face in the surgery.
The breakdown is revealing: another 10 million (39 per cent) were on the phone and the remaining 900,000 were home visits and video calls, which perhaps casts a different light on the controversy.
But, as Alek Perkins, 83, a retired operations manager from Hightown, points out again: ‘What is the use of a GP’s surgery without a GP?’
n Additional reporting Mark Branagan and Tim Stewart.