Sick patients are refusing sick leave from their GP because they can’t afford time off work, while doctors suffer “moral suffering” because they can’t do more to help those most vulnerable, the new head of Britain’s GPs has revealed .
More and more patients are suffering from asthma attacks or other serious breathing problems because they can’t afford to heat their homes, said Dr. Kamila Hawthorne, Chair of the Royal College of GPs, while many report deteriorating mental health due to financial strains.
Rising food costs are also leading to increases in fatigue, mouth ulcers and weak muscles, with people deficient in essential vitamins because they cannot afford to eat anything but a poor diet.
So many patients have complex physical and psychological problems related to poverty, domestic violence, child abuse or poor housing that GPs suffer mentally from their inability to take the necessary action, she said.
Hawthorne, a GP in the Welsh Dales, warned that ill health linked to increasing pressure on household budgets would also put an even greater strain on already stretched GP services.
It comes as medical leaders warned that more GPs are leaving the profession than entering it, and Hawthorne said new trainees entering the profession “will not be enough” to meet growing healthcare needs.
Hawthorne said: “Recently I’ve had patients who refused to take sick leave because they couldn’t afford not to work. When it’s clear that someone needs a break, they often don’t take it.
“These are people who ideally shouldn’t be at work from a medical point of view [because] they have a chronic condition such as asthma or diabetes, but quite often mental health problems, fairly severe mental health problems, I [see] Some cases that really need some peace and quiet in the infirmary to try and help them get better.
“I was really surprised over the last year that when I offered sick leave they said, ‘Oh no, no, I can’t take time off. I need the money from work.” They refused. They say, ‘I have to keep working to earn money and support myself and my family.’ I don’t take it personally, of course, but I feel sorry for people because you step into their lives for a few minutes and you see it’s really tough.”
Those declining to take sick leave are primarily young to middle-aged adults, including people who work in call centers, but it’s also seen among people with young families and the elderly, Hawthorne said.
Soaring food and energy prices have meant some patients cannot afford transport to GP appointments she and her colleagues are performing near Pontypridd – or even to get to the hospital for pre-booked treatment.
Her comments came as Rishi Sunak warned this winter would be “challenging” for Britain due to rapidly rising prices, strikes and long waits for NHS supplies.
The prime minister told the cabinet at their weekly meeting on Tuesday that the coming months would bring widespread misery as they debated how to ease the crises. A No10 spokesman said: “Looking ahead to winter, the Prime Minister said it would be a challenging time for the country caused by the aftershocks of the global pandemic and the ongoing conflict in Ukraine.”
The coming cold spell will only worsen the health and well-being of patients, Hawthorne fears. “The livelihood crisis has been around for a long time. But in the last few months it has suddenly gotten much worse. I now have patients who are concerned about heating bills this winter who have not yet turned on their heating and are keeping their windows closed.
“People are very, very concerned about what is to come and whether they will have to choose between heating and eating.
“The moral distress among GPs comes from not being able to do more [to help people with complex problems]. We can help most people who come to us, for example with a rash, menstrual cramps, or anxiety and depression. However, we are seeing more and more people with persistent social and psychological problems that are very difficult to solve,” she said.
She added: “Some people have really terrible stories. GPs are trained to help people find their way around. But when we, as GPs, are faced with one unsolvable problem after another, it can be quite unnerving.
“The sense of hopelessness that the patient brings carries over to you as a GP. When it comes to patient after patient after patient, you really do feel like a squeezed lemon at the end of the day. It’s quite exhausting.”
GPs are also concerned that patients’ health is deteriorating from being stuck on NHS waiting lists for so long, she added. “It’s mostly people with sore hips and knees, people who are now crawling up the stairs because they can’t go up and the only toilet is at the top.”
Hawthorne said she’s also noticed a rise in folic acid deficiency, a lack of B vitamins in some patients, spurred by poor diets triggered by poverty. She urged ministers to spend more on energy and food vouchers for the most vulnerable patients.
Expanding entitlements to free school meals would also help ease the desperate situation some families had found themselves in.
Hawthorne also slammed ministers for “GP bashing” and their recent pledge that patients could see a GP within two weeks and on the day if it is urgent, which she says ignored underlying issues. “Ministers need to know that this policy is unworkable. The number of general practitioners is falling and the number of patients we treat is increasing. Being a GP becomes untenable, unfeasible, undoable. It’s such a grind that people are retiring as soon as possible.
“Insisting on that two-week rule when they know access to GPs is a problem is actually going to make the problem worse.”
In 2022, 4,032 prospective GPs were placed on internships, according to new figures published by Health Education England. Hawthorne said she was “encouraged” by the number of new hires but warned it “will not be enough to meet current or future healthcare needs”. The Royal College has estimated that up to 19,000 GPs could leave the profession in the next five years due to workload.
A Government spokesman said: “We appreciate the hard work of GPs and are doing what we can to support them and patients during these challenging times, including prioritizing the NHS with an additional £6.6billion on top of previous record funding, according to the Autumn Statement.
“We remain committed to expanding the GP workforce and in September 2022 nearly 2,300 more full-time equivalent GPs were working in GPs than at the same time in 2019 – while a record number took up GP positions last year. ”