The government is trying to deflect the blame away from the real causes of the NHS' crisis, writes Dr Joe McManners.

Dr Joe McManners is a full-time GP, and a former Oxford City councillor.

It is a familiar conversation. The middle-aged man, who I usually have a good rapport with, rings up to speak to a receptionist. He is not a happy man, he has had to wait a while for the phone to be answered, then takes up more precious receptionist time to make his views known about this.

He appears on my ‘triage list’ as he insisted on speaking to a GP, even though I can see from the ‘slot’ notes that the reason is to complain about a hospital waiting list. He was referred last year for sciatic back pain, and after spending a painful amount of time waiting for an appointment was then given an appointment for a scan, miles away from where he lives, which he then cancelled, and he was discharged.

After spending some time working up the ladders of the referral game, he has slid all the way down the snake to the start. He recounts this whole story which takes over the nominal time allocated for this, and at the end of this I have to give my usual weary and frustrated speech: I agree this is deeply unsatisfactory, but I have no control over his experience.

During this time, patients who find it harder to get through to us give up and head to A+E. Repeat this futile exercise several times a day in for every GP practice across the country.

We need to be honest: the NHS is in a terrible state. The big lie being spun by the government is that this is due to the pandemic. Covid-19 maybe the fatal blow, but the NHS has been in critical health for the last decade, deteriorating every year.

We went into this pandemic in a poor state: record waiting times, a crumbling estate, a neglected and depleted workforce, bodged reforms. The list goes on. The question now is: have we reached a tipping point?

This is the point where what we see is not the proverbial frog being slowly boiled, but a trigger for a chain reaction of problems that quickly escalate to an emergency: like a slowly melting glacier that suddenly breaks off – triggering a tsunami.

What is happening in front line services such as Primary Care, ambulances, and A+E is a domino effect. It is a classic ‘system failure’; failure to meet need amplifies pressure elsewhere, which in turns reverberates and multiplies through the health system.

Demand for appointments has rocketed, a combination of delayed problems through the pandemic and increased viruses from opening up. Add this to a workforce and a system that was barely coping anyway, and the NHS becomes saturated; and finally flooded.

There is a multiplying effect for every patient that has a problem that is suitable for primary care but is not dealt with here, and who makes their way to secondary care. This ‘gate-keeping’ function when working is not a barrier to other services, but it is a filter that only lets through patients whose needs cannot be met in primary care.

When it functions, the rest of the NHS is protected to deal with only patients who need more specialist care. When it breaks down, as it is now, the rest of the NHS is overwhelmed by primary care problems.

Around 1.5 million patients a day have contact with the NHS, around 55% of this is in primary care, only around 4% is in A+E. If 1% of those patients attend A+E instead of  primary care, this would represent a 13% increase in A+E attendances.

Aside from this being a lot more expensive way of providing care, it often does not even meet the basic need that led to this. For example, a mentally distressed patient is likely to need a sympathetic GP and an accessible counsellor, not a crowded A+E department who can only patch them up.

The increase in urgent pressure on hospitals means that resources are pulled away from less urgent services, this in turn increases waiting times, strips back ‘routine’ services and returns hospital work back to primary care. And the cycle of failure continues to turn.

It doesn’t have to be like this. This ‘super-crisis’ was long in the making; it can be reversed but will take time and a level of competence and dedication from the government many times greater than we have seen – one with ambitious and specific plans for investment, workforce, social care, waiting lists, preventive health and so on.

Instead of this, we are seeing a desperate campaign against the very NHS staff trying to deal with this mess, aimed to deflect the blame away. It has started with attacks by Ministers and their media stooges on Primary Care, and will inevitably be extended to others in the NHS. No-one should be fooled by this, the finger of blame for this point sonly in one direction.

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