Last week’s assault on staff at a GP practice in Openshaw was a grim display of violence.

Four members of the team at Florence House Medical Practice in Openshaw were injured; a GP suffered a fractured skull.

For many healthcare professionals working in Greater Manchester, it was sadly a new low in a disturbing trend playing out across the NHS.

READ MORE: 'We've got nothing left to give': A day in the life of a Manchester GP battling huge demand, a new appointments system and vile abuse

Through the waves of the pandemic last year, doctors, nurses, paramedics and carers became beacons of hope in the fog of fear and uncertainty. In Greater Manchester, where communities were among the worst hit in the country, families gathered weekly on doorsteps to clap their respect.

Which is what makes the insidious shift from grateful to resentful - and in some cases rageful - even more disturbing for those on the receiving end.

Due to an NHS under unprecedented strain, there are definitely issues for patients accessing healthcare.

But many of the front line staff we spoke to believe the anger they are witnessing also stems from the stress of the last 18 months, the way in which Covid has exacerbated existing inequalities - and even to a Government ‘shifting blame’ to the very workforce that got them through the pandemic.

Oldham GP Dr Fareeha Saeed

The GP

Last week, staff in Dr Fareeha S aeed's Failsworth practice were verbally abused by a patient who refused to wear a mask. After a prolonged tirade of shouting and swearing, she was asked to leave.

“More and more patients are getting angry and shouting, often about trivial things,” she says.

“We do feel like we’ve become the villains. It almost feels like all the anxiety of Covid that built up over the last year-and-a-half - the lockdowns, the stress of Covid, cancelled hospital appointments, cancelled family get-togethers - we are being held responsible for.”

“All of a sudden we are the bad guys.”

Dr Saeed, of Failsworth Group Practice, is not alone. In an interview earlier this week, Dr Manisha Kumar told the Manchester Evening News of the challenges facing GPs.

According to figures from Manchester's Clinical Commissioning Group which covers 85 practices and a population of more than half a million people - 60 per cent of appointments in July were face-to-face.

And Dr Saeed insists she’s seeing 28 of her 35 daily patients in person, adding: “We are one GP down because they have tested positive - probably through seeing patients - and another was off self-isolating last week."

These staffing challenges, combined with flu jabs, boosters, a huge backlog of patients who held back during the pandemic, and the need for infection control, are all adding pressure.

“Covid is still there, we are still dealing with it,” adds Dr Saeed, who argues the NHS needs a ‘structural overhaul’.

“And on top of that verbal and physical abuse has gone sky high, it’s all over our Whatsapp groups,” she adds.

Findings from a recent BMA survey found that more than half of GPs and almost a third of hospital doctors have faced recent abuse from patients, or those accompanying them, in the last 18 months.

And that increase in abuse extends beyond GP practices to other NHS workers.

Dr Mohsan Ahmad

The Dentist

Dr Mohsan Ahmad, a dentist at Glodwick Dental Centre in Oldham, has twice experienced abuse serious enough to trigger police responses in the last six months, but the verbal assaults come almost daily.

A fortnight ago, a patient who wasn’t registered began verbally abusing staff when he turned up without an appointment.

Dr Mohsan recalls: “He was swearing at staff, threatening patients in the waiting room, threatening staff. We had to hit the panic button and call the police who made him leave.”

He adds: “We can clearly understand the frustrations patients have when they can’t access NHS dental services. But on a daily basis the staff get verbal abuse on the phone or from people walking in who aren’t a patient at the practice,” he says.

“There’s foul language, threats of bricks being thrown through our windows, threats to hurt staff if they don’t get an appointment.

“It was very rare before Covid, but just in the last 18 months it’s gone crazy. It’s wearing them down.”

As is the case with GP practices, patients are becoming frustrated when they can’t get a dental appointment.

However, dental practices are restricted by a Government contract which caps the number of NHS patients they can get funding for.

When patients are then told by a practice unable to accept more patients to call the ‘emergency dental services’ number, this is to get them an appointment at one of 80 practices across Greater Manchester - including Glodwick Dental - that provide 200 slots a day.

Dr Ahmad, also chairman of the Greater Manchester Local Dental Network, says: “Some patients don’t know about emergency dental services and we can appease them by giving them the number, others want to come to us and don’t want to go anywhere else.”

As with all realms of healthcare, Covid has hit hard when it comes to infection control.

After any procedure that creates aerosols - which covers a vast number - the entire surgery must be closed for 30 minutes to allow the air to clear, before a thorough clean. If there are four treatments in a day, that can equate to losing two hours.

Dr Ahmad, whose wife is also a dentist at the practice and is now receiving treatment for long Covid, adds: “We are trying but morale is low.

“I love dentistry, that’s what I do. I don’t do any private work and that’s what I’ve done for 16 years. Nothing would make me doubt this profession but what upsets me is that people don’t understand the pressures and allow their pent-up anger to be taken out on people who are trying to help them.

“Our main message is that dental practices are open, we are prioritising patients based on risk and we are open to offering urgent appointments.”

The Greater Manchester Commissioning Team have identified £2m funding to target dental access issues and there are talks under way to renegotiate the Government contract.

If you need an emergency appointment and don’t have a dentist you can call 0333 332 3800 from 8am to 10pm.

Luvjit Kandula

The Pharmacist

Pharmacists are leaving their jobs amid a torrent of abuse which ranges from online messaging and threats to physical assaults, says Greater Manchester pharmacy boss Luvjit Kandula.

A colleague, she says, was recently hit over the head while at work. He was rushed to A&E and the police were called.

“Reports of violence are now nearly a daily occurrence,” she says.

“I’ve spoken to colleagues who are planning to leave their jobs or have left due to the pressure. The abuse isn’t just face to face, it’s on the phone.

“People are very frustrated and this is occurring across all NHS settings. It needs to be addressed urgently.”

Luvjit, who is director for pharmacy transformation across Greater Manchester, describes ‘unprecedented demand’ for advice for long-term and minor illness, as well as supply and delivery of drugs.

There has also been a spike in Greater Manchester of pharmacists asking for ‘temporary suspension of services’ - when pharmacies shut to clear their backlogs.

“The phones are off the hook, we have stock and supply issues that are taking longer to resolve and patients are starting to feel anxious and frustrated," she says.

“The workload has increased in the last 18 months."

Despite this, and amid a staffing shortage which makes finding locum workers a huge challenge, funding for pharmacies has not increased.

According to a recent report by the Pharmaceutical Services Negotiating Committee, there are around 1.1m informal consultations every week - equating to more than 120,000 at Greater Manchester’s 700 pharmacies.

A quarter of those appointments are informal, where people are signposted or can’t access other services.

An audit has shown that every week unpaid pharmacy advice is preventing 70,000 people from going to A&E or an NHS walk-in centre and saving more than 74 appointments for every single GP practice across England.

A separate survey, meanwhile, shows that 60pc of pharmacies are under ‘intense pressure', while 90pc had experienced abuse in the previous month.

“It’s not acceptable. People are working 12 to 14 hour days, they are doing their best to serve the public need. We absolutely recognise the frustration but it’s demoralising and upsetting for members of our pharmacy communities and wider primary care."

Luvjit has appealed for national recognition of the pressures pharmacists - who were a ‘lifeline’ for patients throughout the pandemic - are facing to ensure patients access treatment.

Their work taking pressure off other parts of the system is vital, she says, but the Government needs to recognise the challenges, as well as the impact on staff’s wellbeing and mental health.

She’s calling for increased funding for more staff in community pharmacies and 111 call centres, as well as for GP practices, dentists and optometrists.

She adds: “We need support from the Government to help citizens and patients understand the pressures to find solutions. We need a partnership between citizens, national government and local healthcare system leaders.

“It’s increasingly difficult to manage public expectation. I feel this is just the start of something that could get potentially worse if not addressed very quickly.”

Luvjit’s key message is that lots of illness can be safely managed at home or with a trip to a local pharmacist, who can tell you if the case needs to be escalated.

“But we absolutely do need support from the government, it needs to be a partnership approach to get over this hump,” says Luvjit.

Ambulances queue outside Stepping Hill

The Paramedic

In many ways, the state of a health system’s emergency response is a fair barometer for the state of play more generally.

And with reports of patients waiting up to 18 hours for an ambulance, as well as images of ambulances queuing outside A&E, and the escalation this month to ‘REAP 4’, indicating ‘extreme pressure’, the North West Ambulance Service is feeling the strain.

Paramedics are experiencing the backlash from patients.

The scene outside this Stockport hospital shows a system under strain

One paramedic who asked not to be named told the Manchester Evening News : “People are waiting a long time and we are the people who are the first to arrive.

“Half the time you can’t blame them for being upset but we do get abuse for that, there’s a lot of swearing.

“It’s mostly verbal, although often when we explain the situation and how the service is currently then people do seem to calm down.

“Unfortunately when you’ve got someone who’s poorly and waiting for an ambulance people do get upset.

“It’s down to staffing levels, vehicles and all the rest. That’s never ending.

“But since Covid there has been a change and unfortunately, we are often the first thing people see and they do get upset. If you put yourself in their position you can understand the frustration but we can only do our job to the best of our ability.

“It’s not the crews’ fault. It’s a sad state at the moment, there are all kinds of frustrations out there and people get worked up.”

Dr Zahid Chauhan says the Government needs to start being honest with patients about what the NHS can provide

What is needed to help patients and healthcare staff?

Patients at the sharp end of an NHS under strain are, understandably, frustrated and angry.

There are major issues in the system, caused by what many medics have branded a ‘perfect storm’ of existing gaps in healthcare pathways, funding, resources and the workforce, exacerbated by Covid, as well as a rise in unseasonal illness caused by lockdown, plus a massive backlog of patients.

Meanwhile, inequalities that existed before Covid have been highlighted by the crisis.

It's led the British Medical Association to call for ‘urgent action’ after four-hour wait statistics showed a stark difference between the level of care in emergency departments in the North West compared to the South East.

Those inequalities extend to all realms of people's lives - and those frustrations could be coming to the fore in patients' interactions with clincians, says pharmacist Luvjit.

"The frustration is not just linked to access to services. People may have been impacted mentally and physically by Covid itself. Maybe losing their job, other domestic circumstances. I think there are many inequalities that need to be addressed," she says.

"I think people are taking it out on the people in front of them for things that in normal circumstances wouldn't be an issue.

"The problem is more complex than straightforward needing to access healthcare. People need support, jobs, welfare."

Those on the front line can see the patient perspective and are sympathetic to it.

They point to structural problems, historic workforce deficits, Government contracts capping dental patients, funding gaps - but most significantly - a lack of true understanding from leaders of what's actually going on.

This week Dr Richard Vautrey, MBA GP committee chair, spoke of ‘grave concerns’ around health Secretary Sajid Javid’s ‘lack of support or public challenge to increasing incidents of abuse and misinformation’, as well as an ‘anti-GP rhetoric’.

Dr Saeed from Failsworth agrees: “It’s not good for morale, especially when politicians with no background knowledge are joining in. There needs to be structural change. The NHS is on the verge of collapsing. It needs an overhaul. Even putting extra money in won’t help, it needs real change not just a money dump."

Dentist Dr Ahmad adds: “We know that NHS dentistry has been under-funded for the last 25 years and the current contract doesn’t help matters.

“Politicians play a game to appease the people who are going to keep them in power and what’s happening is just clear shifting of the pressures on to the people who have helped them through the past 18 months.

“All these NHS workers volunteering in vaccination centres while they were giving out million pound PPE contracts to friends. Now they are trying to shift blame and pressure off themselves.”

Dr Zahid Chauhan

Dr Zahid Chauhan, a Greater Manchester GP, meanwhile, has described the ‘nasty politics’ exacerbating huge pressures in the NHS.

“The Government has not admitted they are failing, they are just diverting attention.

“Abusive behaviour has become the new normal. We need to look at the underlying reasons.

“There’s pressure in the system and all that frustration is demonstrated on the doorstep of primary care.

"What happens when your Prime Minister and health secretary start saying your GPs need to get their acts together? More and more people will be abused. We need to have open public statements about zero tolerance of abuse - not say things that add fuel to the fire by using GPs and primary care as a scapegoat for your own failures.

“That’s how you end up with doctors with broken skulls. The next thing is people asking themselves 'why do we do this?'

“We can go and do something else with less stress and more respect.”

Pharmacy boss Luvjit, meanwhile, emphasises the need for better communication between patients, healthcare professionals, local leaders, and National Government.

She adds: “I think overall the government need to review their position and try to understand what we are facing on the ground.

"It’s always about communication in the end."

What the Department of Health and Social Care say:

“We’re hugely grateful to GP practices for their hard work and dedication to bring appointment numbers back to pre-pandemic levels, with over 330 million delivered in the last year.

“Violence and abuse towards NHS staff is appalling - we are taking action to protect staff through the NHS Violence Reduction Programme and the NHS works closely with the police and the Crown Prosecution Service to bring offenders to justice.”

“We are investing £270 million to expand GP capacity, on top of providing £1.5 billion to the sector until 2023/24 to deliver world-class care to patients.”

As background, the Dept of Health added this:

  • Accessing general practice services has changed during the pandemic, with practices offering triage and remote consultations alongside face-to face appointments, in order to see as many patients as possible while protecting staff and patients from infection risks.
  • In July 2021 there were 1.27 million appointments in general practice per working day including Covid-19 vaccination appointments delivered in general practice, an 8.1% increase compared to 1.17 million in July 2019.
  • The GP Patient Survey 2021 reported that 83.0% of patients described their overall experience of their GP practice as good or very good.
  • In 2020 we committed at least an additional £1.5 billion in cash terms for general practice until 2023/24 for additional staff to deliver our manifesto commitments. This is in addition to the £4.5 billion real terms annual increase announced for primary and community care in the Long Term Plan by 2023/24.
  • To support practices to cope with the demands of the pandemic, a £270m General Practice Covid Capacity Expansion Fund has been introduced.
  • We will create an extra 50 million appointments per year in general practice by growing and diversifying the workforce. This will mean improved access to general practice for patients, and support for staff to provide a wider range of care options for patients outside of hospital.
  • NHS England and Improvement and HEE are working together with the profession to increase the general practice workforce in England. This includes measures to boost recruitment, address the reasons why doctors leave the profession, and encourage them to return to practice.
  • The highest ever number of doctors accepted a place on GP training in 2020 (3,793 against a target of 3,500). From 2021, the government has committed to increasing the number of GP training places to 4,000 a year.
  • In October 2020, £15 million was announced to strengthen mental health support for healthcare staff in 20/21, and the NHS has since confirmed a further £37m for 21/22 to enable the continuation of this offer – with 40 dedicated support hubs which are either established or currently mobilising across the country.

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