Is there a GP appointments crisis?
News reports claim there’s a crisis in your doctor’s surgery, with patients struggling to get appointments. Lucy Trevallion investigates the reality and what it means for you.
It has been called a “staffing crisis”, “workload crisis” and “funding crisis” by journalists and by some politicians. General practice is “on the brink”, “near meltdown”, “failing” and “crippled”, according to headlines. Some news reports suggest that people who need regular check-ups, such as those with heart conditions, simply can’t access GP appointments.
Is this media scaremongering, or is there a real problem? “We can definitely see signals that people are struggling a bit with getting appointments,” said Beccy Baird, Health Policy Fellow at think tank The King’s Fund. “The latest National GP Patient Survey shows that satisfaction levels have been declining since 2012 in England, but they are still very high.”
We can definitely see signals that people are struggling a bit with getting appointments
Health Policy Fellow at The King’s Fund
Nearly three out of four patients rated their experience of making an appointment as ‘good’. Asked how people felt about the time it took to access care, 62 per cent thought it was about right, but 31 per cent thought it took too long.
If there is a crisis, it still isn’t obvious to most patients. However, declining satisfaction levels are matched by what doctors say. In a British Medical Association (BMA) survey, more than 70 per cent of GPs thought it had become more difficult to access NHS care in the previous 12 months, with many respondents noting long waiting times for GP care.
“I think we’re close to a tipping point where there’s just not enough capacity to meet the demand,” Ms Baird said. “General practice is really under stress at the moment.”
GP capacity and demand
It is difficult to understand how demand is outstripping GP capacity, as there are no official figures on GP activity. “This is the biggest problem in general practice,” said Ms Baird. “We don’t know how many consultations there were last year, and what they were for.”
It is difficult to understand how demand is outstripping GP capacity, as there are no official figures on GP activity
The King’s Fund has gathered its own data in the 2016 report ‘Understanding Pressures in General Practice’, which painted a picture of soaring workloads. It found that between 2010-11 and 2014-15 there was a 13 per cent increase in face-to-face GP appointments and a 63 per cent increase in telephone consultations – a trend that is continuing.
This rise in demand is due to an ageing population, an increase in the number of people with multiple long-term conditions, and the fact that GPs are being used to take strain away from hospitals.
What’s behind this?
The latest estimates from Royal College of General Practitioners (RCGP) member surveys and data suggest the UK needs an extra 8,000 GPs. There are currently around 61,000.
“The government pledged 5,000 more GPs by 2020,” said Ms Baird. “Short of an influx of GPs from abroad, I don’t think they’re going to meet their target.”
In response, a Department of Health spokesman said: “Not only do we currently have the highest number of GPs in training ever, but we are also doing lots to attract even more GPs to the profession - agreeing a pay rise, cutting red tape and bringing in new schemes to help GPs work more flexibly.”
There has been a steady 10-year decline in the proportion of NHS budget going to primary care
Funding is another big issue. There has been a steady 10-year decline in the proportion of NHS budget going to primary care, hitting an all-time low in 2016-17 of 7.2 per cent. The GP Forward View aims to redress the balance and move this up to about 10.5 per cent of the NHS budget by 2021.
Simon Stevens, Chief Executive of NHS England, said that this will mean further investments in staff, technology and GP premises.
But Professor Helen Stokes-Lampard, Chair of the RCGP and a GP herself, said this funding does not go far enough. “The 10.5 per cent would go a long way to helping to ease the pressures that we have now, but by the time the change is implemented new pressures will be upon us.”
Focus on urgent care
The result of this increased demand is a focus on urgent appointments. “We have to prioritise people who are acutely unwell, so it makes getting routine appointments more difficult,” said Professor Stokes-Lampard.
A survey of GPs for Pulse magazine estimated that the average waiting time for a non-urgent appointment in 2016 was 13 days. “People with long-term conditions who need ongoing care, and this will be a lot of Heart Matters members, might happily wait a week or even two for a routine appointment,” Ms Baird said. “But when they’re told that their next bookable appointment is in six weeks, they’re going to call at eight o’clock the following morning for a crisis appointment. This diverts more attention to urgent access. It’s a vicious circle.”
Taking action to help GPs and patients
The government has introduced measures to try to help GPs, such as reducing insurance costs. To help with their workload, some GPs are including a wider variety of roles in their teams, such as pharmacists and nurse practitioners (specially trained nurses who can prescribe and treat certain conditions), while others are combining practices to give them flexibility.
To help with their workload, some GPs are including a wider variety of roles in their teams, such as pharmacists and nurse practitioners
Patients can also think about whether they need to see a GP: for some ailments, pharmacists can help – they can talk to you confidentially, manage your repeat prescriptions and advise on medicines.
Professor Stokes-Lampard said: “We don’t want patients to be concerned; the NHS will always be there for them when they really need it.
“If you do have difficulty getting an appointment with your surgery, please understand that it’s not personal and your surgery will be doing everything they can to see you and help you. Don’t be afraid to give online or phone consultations a go – you may be pleasantly surprised.”