Sick patients are refusing sick notes from their GP because they can’t afford time off work, while doctors are suffering “moral stress” because they are powerless to do more to help the most vulnerable, the new leader of Britain’s GPs has revealed .
More patients are experiencing asthma attacks or other serious breathing problems because they cannot afford to heat their homes, said Dr Camilla Hawthorne, president of the Royal College of General Practitioners, while many report poorer mental health due to financial stress .
Skyrocketing food costs are also leading to increased fatigue, mouth ulcers and weak muscles, with people deficient in key vitamins because they can’t afford to eat anything but a poor diet.
So many patients have complex physical and psychological problems related to poverty, domestic violence, childhood abuse or poor housing that GPs suffer psychologically from their inability to take action, she said.
Hawthorne, a GP in the Welsh valleys, warned that the disease, linked to increasing pressure on household budgets, would also put further strain on already overstretched GP services.
Dr Camilla Hawthorne, the new chair of the Royal College of GPs, said: “GPs are suffering psychologically from their inability to take the necessary action.” Photo: Justin Grange
She said: “I’ve had patients refuse sick notes recently because they can’t afford not to work. Quite often, when it’s clear that someone needs a break, they won’t take it.
“These are people who ideally, medically, should not be at work [because] they have a chronic illness like asthma or diabetes, but quite often mental problems, quite severe mental problems, i [see] some cases that really require some peace and quiet to try to 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 have refused. They say, “I have to keep working to earn and support myself and my family.” I don’t take it personally, of course, but I feel bad for people, because for a few minutes you walk into their lives and you see that it’s really difficult.”
Those refusing sick notes are mostly young to middle-aged, including people who work in call centers, but it’s also seen in people with young families and older people, Hawthorne said.
Rising food and energy prices have left some patients unable to afford transport to attend appointments at the GP surgery she and her colleagues run near Pontypridd – or even to get to hospital for pre-booked treatment.
Her comments come as Rishi Sunak warned that this winter will be “challenging” for the UK as a result of skyrocketing prices, strikes and long waits for NHS care.
The prime minister told the cabinet at their weekly meeting on Tuesday that the coming months would bring widespread unhappiness as they debated how to ease the crises. A Number 10 spokesman said: “Looking ahead to the winter, the Prime Minister said it would be a challenging period for the country caused by the aftershocks of the global pandemic and the ongoing conflict in Ukraine.”
The coming cold weather will make things even worse for patients’ health and well-being, Hawthorne fears. “The cost of living crisis has been around for a long time. But it suddenly got a lot worse in the last few months. Now I have patients who are worried about fuel costs this winter, who have not yet turned on their heating and are keeping their windows closed.
“People are very, very worried about what lies ahead 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 because they have, for example, a skin rash, period problems or anxiety and depression. More and more, however, we see people with intractable social and psychological problems that are very difficult to resolve,” she said.
She added: “Some people have a really terrible story. GPs are trained to help triage people. But when as GPs we are faced with intractable problem after problem, it can be quite exhausting to watch.
“That sense of hopelessness that the patient carries with them carries over to you as a GP. When patient after patient after patient, you go home really at the end of the day feeling like a squeezed lemon. It’s quite exhausting.”
GPs are also concerned that patients’ health is deteriorating because they have remained on NHS waiting lists for so long, she added. “These are especially people with painful hips and knees; people who are now crawling up the stairs because they can’t go up anymore and the only toilet is upstairs.”
Hawthorne said she has also seen an increase in folate deficiency, a lack of B vitamins, in some patients fueled by a poor diet brought on by poverty. She urged ministers to spend more on energy and food vouchers for the most vulnerable patients.
Extending free school meals would also help alleviate the desperation some families find themselves in.
Hawthorne also criticized ministers for “insulting GPs” and their recent promise that patients would be able to see a GP within a fortnight and on the day if it was an emergency, which she said ignored the underlying issues. “Ministers must know that this policy is unworkable. The number of GPs is decreasing and the number of patients we see is increasing. Being a GP becomes unsustainable, unworkable, overwhelming. It’s such a job that people retire as quickly as possible.
“Insisting on this two-week rule when they know access to GPs is a problem will actually make the problem worse.”
The Department of Health and Social Care has been approached for comment.
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