A doctor has opened up about the pressures facing healthcare professionals and pleaded with the public to "work together" with GPs after 18 months of facing vile abuse.
Dr Manisha Kumar has been a GP for 20 years and is one of Manchester's most experienced doctors, admitting that she has never wanted to be anything else, reports the Manchester Evening News.
But like all of her colleagues, she is facing unprecedented demand due to a combination of factors including ill health due to Covid, unmet health need due to the pandemic, the backlog of elective care procedures and changes to care in the community.
"As a good family doctor, you see someone going from birth to marriage to children to older age, it's a privilege to look after someone their whole life," she says.
"You really understand a whole family and the person you are treating and that is the way you can make a difference.
"It's that mutual understanding, that trust that you build up over the years, and that is something that I think we should never, ever lose as part of a healthcare system.
"I still wouldn't do anything else... I've thought about being a florist, that must be a happier job! But I don't know what else I could do."
Although she loves her job and loves her patients, for the first time in her career Dr Kumar is worried about what the future holds.
Perhaps the biggest change is the move to integrate General Practice into the digital world. Patients can now submit an online form requesting care from Dr Kumar's practice, the Robert Darbishire in Rusholme, 24 hours a day, seven days a week.
Each morning, the practice then has to tackle the task of triaging these online requests, as well as prescription requests, blood results and people walking in and ringing up for appointments.
On a typical day there can be between 60 to 80 requests per GP.
Doctors are working up to 14 hours a day just to try and tread water and that's before the expected surge of illness expected in winter.
"I've been at the Robert Darbishire for 17 years and it is a hard place to work, it's inner city, we've got a lot of people living in deprived communities, we have lots of people with additional language needs," said Dr Kumar.
"And I've enjoyed that in the past because you feel like you're adding value and you're really needed by the community that you're serving.
"I've cried and I'm one of the most experienced GPs in the city. At the end of the day you've got nothing left to give."
The number of GPs quitting or taking extended leave due to 'burnout' is on the increase - an average of three a day left the job towards the end of 2020.
New doctors can’t be trained quick enough to replace them - with a shortfall of 7,000 GPs expected by 2023.
"Many [GPs] haven't taken leave for the last 12 months. I took 10 days holiday last year I think," said Dr Kumar.
"You don't want to leave your colleagues to pick up when you're away.
"They've done that because it was the right thing to do for the patients - and I think what's hard is patients aren't appreciating the changes we've made and the reasons we've made them.
"It's for them, it's not for us, it's not to give us an easy life because it really doesn't."
While the majority of patients continue to be 'wonderful', says Dr Kumar, an increasing minority are venting their frustrations over the new appointment system.
Dr Kumar accepts that there is a challenge for General Practice to help the public understand the change in 'mindset' over appointments.
But too often patient behaviour is unacceptable and leaving GPs and practice staff fearing for their safety.
"I think we're probably one of the only open services, like the police, to hear people's frustrations and that's really, really difficult," she said.
"Because it's misplaced, it's often due to reasons that we can't actually solve, and it doesn't help us deliver high quality care.
"You're facing a level aggression... and I'm trying to phrase this the right way... there's always been tough times and in the course of a week you handle it, we're trained to handle it, whenever people are unwell, frustrated or upset."
Reception staff often bear the brunt of patient anger, Dr Kumar says.
"I think people have a different threshold with clinical staff and non-clinical staff," she said.
"The reception staff have had a really, really hard time.
"They're saying 'there's 60 people in front of you, we will phone you today but you need to work with us' or 'the reason you can't book face to face is because we need to control the number of people in the waiting room at any time'."
