GP's plea to patients: 'We are trying our best under difficult circumstances'

Dr Daniel Weaver has spoken out about the overwhelming pressures facing staff at Robert Street Practice in Milford Haven.

In a 2,500-word social media post, Dr Weaver said the practice was currently operating with just 60 per cent of the necessary staff, and frequently seeing between 40 and 60 emergency appointments every day.

"We have effectively close to 3,000 patients per full time equivalent GP," he said - almost double the UK average.

Where are all the GPs?

"This is in part because of maternity leave, and in part because despite spending thousands of pounds on advertising we haven’t had any success in recruiting since a doctor left a couple of years ago."

Dr Weaver said GP shortages was a national problem, but various aspects of life in rural west Wales were further putting potential candidates off.

"Our practice area is one of relative deprivation so any GP applying knows they will be busier then those working in more affluent areas," he said.

"I came to back to work in Milford because I enjoyed working in the town during my time training in Barlow House surgery and I have a family connection to the town, but unless someone has a connection to the area it’s not easy to get people to relocate from other areas.

"Many international doctors in the NHS have families overseas and want to settle in a location with good access to airports etc. or to live in larger cities with people of similar faith or culture."

Medical colleagues had told him that uncertainty about local hospital services was also "making doctors nervous" about a knock-on increase in GP workload.

"The loss of maternity services in the county and loss of 24-hour paediatrics is deterring younger doctors who either have children or are planning to have children," he said.

"Also the state of the secondary schools in Pembrokeshire at the moment puts some off."

'You don't always need to see a GP'

Dr Weaver said the practice had tried employing a physiotherapist to see patients presenting with muscular and joint problems, allowing GPs to see other patients, but most just refused and insisted on seeing a GP.

A triage service was also in place in a further attempt to free up appointment slots, as many issues could be properly managed over the phone, he said.

"The GP can access the notes and takes a history/arranges investigations or a face to face appointment if required.

"We pay for this out of practice budgets.

"It’s not ideal but it is better then nothing and there is no alternative option at this moment in time."

In June the practice, along with neighbouring Barlow House and surgeries in Neyland applied for extra funding for a paramedic practitioner to assist with home visits, but "nothing had been forthcoming".

Robert Street had also attempted to close its practice list, but this request was denied by the health board.

At a Hywel Dda Health Board Community Health Council (CHC) meeting on February 6, members were told that closing the books would place an extra burden on Barlow House.

'Close to collapse'

Reliance on locum staff was also a concern, Dr Weaver said.

He said GPs could potentially earn more money in a week as a locum than in a month as a salaried doctor or partner.

“Locum doctors don’t have to follow up patients or results and usually will cap themselves to a limited number of consultations, e.g 12 in morning or afternoon and one home visit.”

He said existing locums had little incentive to seek permanent jobs with a practice, but - despite the financial and work-life benefits - there was also a shortage of locums.

“We cannot compete with the health board for locums as their rates far exceed what a normal general practice can pay.”

Dr Weaver said there was a “danger about locum work being so lucrative in the current climate, it actually risks destabilising things further”.

“If another doctor left it would cause the practice to collapse entirely and we feel a duty to each other, staff and the local area,” he said.

He said the practice had ambitions of acquiring training status, as there was evidence this could improve recruitment as many trainees ended up in taking a job in a practice they trained at if they had a good experience.

Dr Weaver said there had been the first indications that this process could start, which was good news.

Plea for patience

But in the meantime, Dr Weaver has urged patience among patients.

In addition to long days and on-call duties, GPs also has to deal with letters to and from hospitals, amend medications, arrange tests and referrals, check safety updates for new drugs, review test results, speak to partner agencies such as the Department of Work and Pensions, and deal with end-of-life matters.

Dr Weaver acknowledged it was frustrating that patients could not always get through on the phone, but said: "It’s not ideal but we have a finite number of reception staff.

"At peak times we have up 100 people trying to get through and without a call centre there are likely to be delays."

He emphasises that 'taking out frustration out on staff' was only likely to make the problem worse.

"My colleagues are grafters and work as hard as any clinicians I’ve ever worked with in my entire career," he said.

"Everyone is working hard and it’s not an easy time for anyone."