Laura Mount became a doctor – she visibly winces at repeating such a cliche – to help people. Also, she was good at school. Her dad was a chemist, which is where she got her love of science; her mum, who was a hairdresser, gave Mount her drive. “If you didn’t do well and get on with it, you knew,” says Mount. “She felt she missed out on all that. So she was quite strict. She wanted us to do well.”
Mount, 44, has been a GP for 15 years. She is a partner at the Folly Lane medical centre in Warrington, Cheshire, which is also where she grew up and has lived her entire life, apart from her training in Sheffield. In addition to being a GP, Mount is the clinical director of a primary care network, coordinating six GP surgeries across Warrington. On top of this, she runs a vaccine clinic from a community centre in Orford. “It’s all a bit mad,” she says.
Mount has always enjoyed her job, but lately she has felt dissatisfaction creeping in around the edges. It’s partly the patients. “We call them the Amazon Prime generation,” says Mount. “They’re used to ordering something and it comes the next afternoon.” Three or four years ago, Folly Lane would get a patient complaint every three to six months. “We’d get really upset about it,” Mount says, “and spend ages replying to it.” Now, it’s not uncommon to get a complaint every day.
When patients don’t get what they want, they harangue reception staff. The surgery records incoming and outgoing phone calls, and Mount gets emotional when she listens back to them. If a patient is particularly abusive, Mount will send out a zero-tolerance letter, warning them that if it happens again, they will have to find a new GP practice.
Today, in her treatment room at the beginning of October, Mount writes one such letter. The patient was abusive because they didn’t get their prescription as fast as they would have liked, even though they got it the same day. In her letter, Mount suggests the patient comes in and listens back to the audio of their phone call. The patient won’t take her up on this offer. They never do.
The other thing grinding Mount down is the recent spate of hostile headlines in the press. In May, the Daily Mail launched a campaign to make GPs see all patients face-to-face. The newspaper has condemned GPs for being “overpaid” and “moaning”, suggested part-timers choose not to treat patients on Fridays so that they can “enjoy long weekends off” (a claim debunked by the factchecking organisation Full Fact), accused them of being uncaring, and castigated GPs who choose to work part-time. Similar pieces have appeared in the Times, Daily Express, the Sun and the Telegraph. In September, the Doctors’ Association UK complained to the media regulator IPSO about the Telegraph columnist Allison Pearson’s inflammatory anti-GP rhetoric. (In one column, Pearson urged the public to “turn the heat up” on GPs.)
To Mount and many of her GP colleagues, opening the newspaper every day feels like sticking their hand in a box of sharps. She is in a WhatsApp group for fellow GPs, which lights up as another invective-laden article is published. “I can cope with long hours and being busy,” says Mount. “I don’t mind working hard. I do it for the patients. But when you are actively being slagged off in the media and being made out to be the villain, that is the lowest point of my career. I feel really demoralised.”
What makes the whole thing so infuriating is that GPs were following orders when they switched to remote models of triage. NHS England advised them to do so in March 2020, to mitigate the spread of the Covid-19 pandemic, and did not revoke this guidance until May 2021. And yet in September, the health secretary, Sajid Javid, backed the Mail. “I am grateful to the Daily Mail for launching this campaign,” he said, adding that it was “high time” GPs went back to their pre-pandemic operation models.
This perception that GPs are refusing to see people face-to-face has contributed to increased patient hostility. A September survey of 1,000 GPs from the healthcare publication Pulse found that 74% had experienced increased levels of abuse post-pandemic. Sometimes, patients complain about the lack of face-to-face appointments while sitting in Mount’s office. “I say: ‘What are we doing right now?” she says. In the period October 2020 to October 2021, 48% of Folly Lane’s patients were face-to-face; in pre-pandemic times, this figure was 60%.
While it is true that face-to-face primary care appointments are not back to pre-pandemic levels – in October 2021, 64% of English primary care appointments were face-to-face, compared with 80% in January 2020 – GPs are demonstrably working harder than ever. The number of appointments provided by English primary care increased from 27.2m in January 2020 to 30.2m in October 2021. This is despite the fact that England has lost 1,307 GPs since 2015, nearly 5% of the former total.
“Twenty years ago,” says Prof Azeem Majeed, a GP and primary care expert at Imperial College London, “being a GP was very attractive.” In 2005, Majeed would expect 50 applicants for a GP position at his surgery; now, he’s thrilled if they get one decent candidate. There are two vacant GP positions currently open at his practice.
“All this press about how we aren’t seeing patients,” says Mount. “Well, maybe you can’t see us because there aren’t that many of us, because it’s such an undesirable profession. Don’t beat up the ones who are still around.” Many of Mount’s friends and colleagues have left. Those who remain have to pick up the slack, in an era of ever-increasing patient numbers. Across England, the average number of patients per GP practice is up 22%.
By October, Folly Lane had treated 7,000 more patients than it did in 2019, and there were still two months of the year to go, and winter months at that. “We can’t say we’re full,” says Mount. “It’s uncontrollable. More people will keep coming, and you don’t want to leave them without being seen.”
This is Mount’s account of a winter of exceptional demand.
14 October NHS England writes to GPs, announcing a £250m package for primary care – but only if GPs increase the number of patients they see face-to-face. It also informs them that it will be publishing data on face-to-face appointments, and naming and shaming underperforming surgeries.
“It’s like another kick,” Mount says. “You aren’t doing a good enough job, and we’re going to punish you for it.” Almost immediately, patients start citing the NHS England letter in their complaints. Morale among GPs is at an all-time low – their WhatsApp groups are aflame.
“It’s a job I love,” says Mount. “But some days I also hate it.”
21 October The British Medical Association (BMA) England GP committee rejects the government’s funding package, – specifically the decision to name and shame GPs. It ballots its members on industrial action. English GPs have only gone on strike once since 1975, in a 2012 dispute over pensions. During this strike, GPs continued to treat urgent cases.
“The ballot was a cry for help,” says the BMA England GP committee chair, Dr Farah Jameel. “Saying: ‘We can’t carry on like this any more.’” (While the ballot suggested a range of potential options, a strike of GPs was not on the table.) But the issues predate Covid: for years, primary care has been underfunded. In 2005, general practice received 9.6% of the NHS budget. In 2019-20 this figure was about 8.7%. The BMA has called for a minimum of 11% of the NHS budget to go to GPs.
In a way, GPs have been enacting a private form of industrial action for years now. “The workforce is leaving,” says Jameel. “We can’t retain clinicians. We can’t even retain reception teams. Do we need to organise for it to be a strike?”
Early November Newly installed security cameras blink in the reception at Folly Lane. The partners are spooked: in September, four members of staff were injured in an attack at a surgery in Manchester. Two people had to be taken to hospital with head injuries.
“I have members of my reception team who left because they couldn’t cope,” says Jameel. “They were constantly crying at how they were being spoken to by the patients.” She has found it impossible to replace them, despite advertising the role five times. GPs, she says, are inured to the abuse. “Like boiling frogs,” she says. “We’ve learned to live with it.”
Were politicians to have realistic conversations with the public about the pressures GPs are under, things might be different. “This frustration,” says Jameel, “is because the public is being led to believe that everything is fine, and GPs are lazy, and that’s why you can’t see them. That’s how the public is being stoked. And of course, if that’s what you believe, you would be angry, too. But if they understood the challenges, they might direct that anger at policymakers.”
In Mount’s office, her patients are distressed, with good reason. The pandemic has created a huge backlog in non-Covid care. Between April 2020 and November 2021, there were 4.2m fewer elective procedures, and 29.1m fewer outpatient attendances. In October 2021, 312,665 patients had been waiting more than a year for treatment; in October 2019, this figure was 1,321.
Mount sees a patient in his late 60s who has been waiting months for a urology consultation for a prostate operation. Technically, he’s a low-risk patient, but his condition is seriously affecting his quality of life. He can’t leave the house for more than an hour or two, because he constantly needs the toilet. There’s nothing Mount can do; she has tried medicating the issue but it doesn’t work. He needs surgery.
A woman in her late 40s comes in with a gynaecological issue. The woman has been waiting for surgery for five months. They agree that Mount should refer her to a different hospital where the waiting list is shorter, even though she’ll have to go to the back of the queue. “She’s in pain,” says Mount, “and can’t leave the house for a week or two every month.”
As the afternoon wears on, it seems that almost every patient is presenting with a waiting-list-related issue. They need a hip replacement, or a knee replacement, and they’re in pain. This has never happened to Mount before. “As a doctor, you want to help people,” says Mount. “It’s not nice when you watch your patients suffer, and you have to explain to them why they have to continue suffering.”
12 November Last night, on BBC One’s Question Time, Alastair Campbell excoriated the government for its treatment of GPs. “I’m getting really worried about these attacks on GPs,” Campbell said. “Which I think are being orchestrated.” A colleague shares the clip via WhatsApp. Mount watches it while eating breakfast. “It was nice to hear that someone was speaking up for us,” she says. “Because everyone thinks we’re shut.”
Mid-November Mount spends a day at the vaccine centre. Currently, they are rolling out booster vaccines to over-40s and the clinically vulnerable, although there has been chatter that the rollout will be widened to all adults soon.
Mount is dealing with a routine query when there’s a commotion. Staff peer out of the window. There’s an anti-vaxxer outside. “Only the vaccinated die young!” he chants. Bizarrely, he’s carrying a golf club. Mount is unfazed. He has been coming since spring. Because of him, the practice had to install opaque screens across the windows, so that he wouldn’t be able to view confidential patient information. After a few hours, the man gets bored and goes off to play golf.
The worst anti-vaxxers are the ones who disrupt the clinics. In May, Mount was running a vaccine bus outside the town hall when two anti-vaxxers went to the car park, told everyone the clinic had run out of vaccine, and sent them home.
Late November Mount sees a patient with Covid symptoms. Folly Lane has a designated treatment room for patients with suspected Covid, but the patient is insisting she be seen in a regular treatment room.
The woman, who is in her mid-30s, keeps telling Mount that she believes that she has a bacterial chest infection, and is asking for antibiotics. Mount tells her that she needs to rule out Covid first, and sends her for a PCR test. “People get angry when you ask them to go for a PCR test,” says Mount. “Like you’ve accused them of doing something wrong. They feel like they know it’s not Covid.”
This is a daily occurrence at Folly Lane. “When I say they have to go to a special room, they get upset,” says Mount. “They don’t want to go in that room. That’s the room where patients with Covid have been.” Sometimes patients lie and say they have had a negative PCR, not realising that the results come through to Mount’s computer.
That evening, Mount has a bath when she gets in, and washes her hands. The patient was coughing all over her. The test comes back the following day: the patient has Covid. “It makes me angry that my staff have to expose themselves to the risk because patients refuse to get a test,” says Mount. “They’re expecting us to expose ourselves to the illness. And we can’t say no. We have to see them.”
Despite the fact that Mount’s team regularly see Covid-positive patients, they are not given high-quality FFP3 masks. At the beginning of the pandemic, the surgery couldn’t even get surgical masks from central supply. When they eventually arrived, they had a sticker stuck over the best-before date.
26 November The Omicron variant has been detected in South Africa. Mount has been given orders to ramp up the booster rollout. Her new target, set by NHS England, is to give out boosters to 90% of those eligible by 19 December. So far, she’s at 68%. Mount would like to give out more vaccines, but just doesn’t have the stock. “We are begging for more vaccines,” she says. “We are going as fast as the supply allows.”
Another patient complaint. A nurse used a tongue depressor to examine his throat, and it made him gag. Mount dashes out the response. “I am very sorry for any distress you have felt,” she writes, explaining that use of a tongue depressor is a routine part of a physical examination.
Early December An exhausting day at the surgery. “You have to be fully functioning,” says Mount. “It’s like a conveyor belt. Patient after patient after patient.”
Because minor conditions are screened out during telephone triage and assigned to junior doctors or nurses, every person Mount sees has a complex condition. Appointments are scheduled into 10-minute slots, which gives them a Generation Game-like feel, but with life-and-death stakes.
On an average day, Mount treats 40 patients. According to BMA guidance, any more than 25 patient-doctor contacts a day is unsafe. “We are already at the point where patient safety is being compromised,” says Jameel. “It has been for a long time.” She has colleagues who see or speak to 120 patients a day. Every one of these contacts is fraught with risk. Every one of them is potentially life-threatening.
Mount sees a pregnant woman in her early 30s with abdominal pain. Mount suspects an ectopic pregnancy, which can be fatal if untreated. The gynaecological registrar at the hospital won’t accept the patient without blood tests to rule out appendicitis. But these tests can take 24 hours to come back. Mount pleads with the registrar, who relents. Mount checks the patient’s notes the next day: it was an ectopic pregnancy.
12 December In light of the fact that Omicron cases are rocketing, the BMA has offered the government an opportunity to “reset” its relationship with GPs.
Mount is at home with her family. It’s her son’s 14th birthday. As she cooks his favourite meal – roast chicken and chocolate cake – news breaks that Boris Johnson has scheduled a press conference that evening. Her WhatsApp lights up. “All the GPs are going crazy,” she says. “Saying that the press always finds out about everything before us.” She feels a spike of anxiety: throughout the pandemic, she has found out about changes to the vaccination programme via the news, and there’s no reason to expect this evening will be any different.
Come 8pm, Mount watches the press conference. Johnson announces that all English adults will have the chance to get a booster by the end of the month, provided they had their second dose of the vaccine at least three months previously. People can walk in for vaccines, without appointments. Getting everyone boosted before the new year is to be the NHS’s No 1 priority.
When the press conference is over, Mount opens her laptop. She crunches the numbers: her primary care network needs to deliver 10,000 boosters before January. For context, they have delivered 9,000 boosters since September. They are effectively being told to do three months’ work in three weeks, during the busiest time of year for GPs, when patients present with seasonal flu and staff are off for the holidays.
First, Mount applies for permission for all of the surgeries in her primary care network to become vaccination sites. Then, she emails the team at her vaccination centre, to see what extra dates they can put on. Afterwards, she warns her husband that she won’t be able to see him and the kids much before Christmas. She tells her daughter she won’t be able to take her to the Christmas market in Manchester any more. She cancels all of her days off, leaving only Christmas Eve, for present wrapping.
She sleeps badly and arrives at Folly Lane early the next morning. By the end of the day she has seen 28 patients, reviewed a batch of prescriptions, filled out her paperwork, supervised a trainee GP and a pharmacist, written a plan to increase vaccine capacity to 1,120 doses a day, and obtained all the permits.
“If things feel out of control,” Mount says, “I need to get back in control again, as quickly as possible.”
14 December The Orford vaccine centre is vaccinating 1,000 people a day. The queue stretches around the building.
“A few weeks ago,” says Mount, “ministers were saying not particularly nice things about general practice. We’re doing this for the patients, not for the government. That’s how the NHS runs. It’s on the goodwill of people. Primary care will always deliver.”
Mount puts an out-of-office on her email, informing people that she will only answer urgent queries and emails about the booster rollout. Folly Lane has postponed a few non-urgent disease review clinics. “In three months,” says Mount, “are GPs going to be criticised for what we did have to postpone? Will the government accuse us of earning money from it?”
Her nerves are frayed. She’s exhausted, and living on coffee.
15 December The centre is vaccinating 1,400 people a day. Mount gets a strange email. The person asks for their vaccination data, and then tells them to watch the prime minister’s press conference, later that evening.
Come 5pm, Mount is at the vaccine centre, packing Pfizer vials into freezer bags full of ice to take out to GP practices. She turns on the press conference, and is flabbergasted to hear Johnson thank her personally, for her work rolling out the booster campaign. Her dad messages her almost immediately. “The prime minister just said your name!” he writes.
20 December Mount dashes to Asda to pick up bits for the Christmas meal. She’s so tired, she leaves her keys at the checkout. A member of the public flags her down.
23 December Mount’s final day in the office before Christmas. Across the country, Omicron cases are surging. There are 106,199 cases reported in England today: a new national record, to be broken tomorrow, and the day after that, and the day after that.
Testing labs are overwhelmed by the sheer number of people presenting for PCR tests. Government-issued lateral flow tests have run out. The local microbiology lab is so overwhelmed with PCRs, it has had to stop doing urine and sputum samples. Without the samples, they can’t find which specific infections the patients have, so Mount has been told to prescribe broader antibiotics than she would typically use. “We’ve spent years trying to avoid broader antibiotics because of the problems they can cause,” she says. “We might end up in a pickle next week with people with resistant infections.”
At lunchtime, one of the Folly Lane nurses is getting ready to go out and vaccinate a shelter for rough sleepers. As the nurse is preparing to leave, Mount gets an email from her communications manager. The prime minister wants to video-call her at the homeless shelter, to thank her for the work she has been doing. “I said to the comms lady: ‘Are you sure you want me to do this? I’m known for speaking my mind.’”
Mount has a break in between clinics, and she rushes to the shelter. They cram into a small meeting room. The prime minister is characteristically dishevelled and tries to fix the Teams connection halfway through. After 10 minutes, they click off. “If we’d had more time,” says Mount wryly, “I might have mentioned a few things about how best to communicate with us. But then he’d probably have said that his computer failed.”
Afterwards, Mount and her team vaccinate 30 people at the homeless shelter, which feels amazing. “Sometimes the ones you get the biggest sense of achievement about are the smallest numbers,” she says.
Wrapping the children’s presents on Christmas Eve, Mount realises to her dismay that she ordered far too many online, and sets some aside. “You overcompensate, don’t you?”
29 December Mount is at the vaccine centre. It’s ghostly quiet. They have space for 1,100 appointments, but only 250 people are booked in. Over Christmas, studies emerged indicating that Omicron is less deadly than earlier variants of the virus. Mount thinks this is why people aren’t bothering to book their boosters. “For someone in their 90s or who is immunosuppressed,” she sighs, “it might not be mild.”
Around 11am, anti-vax protesters set up a table outside the centre. “You’re not being told the full picture,” a protester tells people as they leave the clinic. He hands them a leaflet. “How many jabs to freedom?” it reads. “Never before has a ‘vaccine’ required continuous top-up every few months! Surely your gut feeling tells you something isn’t right?”
One of Mount’s team waves at the protesters cheerily through the window. “They had a poster last week with a picture of Madeleine McCann on it,” observes a volunteer, eating a biscuit. Mount asks the building manager if they can’t be moved on, but it’s public land so there’s nothing she can do.
Around 2pm, one of the protesters starts shouting at patients in the observation room. She yells that everyone’s going to die, and it’s all a hoax. Mount tells the woman that she has to leave, at which point the woman falsely accuses her of assaulting her. Mount’s team forms a human chain around the woman, walking her out. The police arrive, investigate the woman’s claim of assault, conclude there’s no case to answer, and leave. The protesters linger outside for a while until a security guard arrives, then disappear.
Afterwards, everyone is worked up. They debrief over cups of tea. Mount is disturbed. “The worry is that you don’t know who could be violent or aggressive towards you,” she says.
5 January Turnout is still low at the vaccine centre. Mount’s more pressing concern, however, is staffing. Two of her GPs are out with Covid, and two of her nurses. The agencies she would usually call for locums can’t help: the north-west has become the centre of Omicron. It’s a similar picture across the country: more than 35,000 NHS staff are off sick. In London, the military has been drafted into crisis-stricken hospitals.
To prevent her remaining staff from contracting Covid, Mount seeks permission to purchase FFP3 masks out of Folly Lane funds. When fitted correctly, FFP3 masks are up to 100% effective at protecting the wearer from infection; surgical masks are only 40-80% effective. In the UK, FFP3 masks are only available to NHS staff performing aerosol-generating procedures. Despite this, when Javid visited an NHS hospital this month, he wore an FFP3 mask; he was photographed talking to an ICU doctor who was wearing a surgical mask. “We’re two years into this pandemic,” says the BMA’s Jameel. “We know that Covid is airborne, and we’re still telling general practice: ‘Here’s a flimsy mask. This will protect you.’”
At Folly Lane, Mount drafts in a paramedic and pharmacist to deal with minor ailments, but it’s not enough, and they have to cancel a diabetic review clinic. She’s worried about patient safety should things get worse. “In the next two or three weeks,” Mount says, “it could get to the point where we just haven’t got the people. I don’t know what we’ll do.”
When she has a moment to think, Mount asks herself how long she can continue working like this; how much longer she can keep driving herself at the expense of her family life, wellbeing and health. Not much longer, in all honesty. She has seen other GPs have heart attacks from the stress. She plans to get out by the time she’s 60, at the latest. “There’s no way I can do this until I’m 65,” she says. “No way.”
Until then, Dr Mount and her colleagues hold together the crumbling edifice of primary care with exhaustion and goodwill. There may not be many GPs to replace her, if things carry on as they are.
Some dates and details have been changed for patient privacy.