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GPs go forth

Pressures force GP practices to halt routine appointment bookings

One in six GPs says their practice had to resort to stopping routine bookings, limiting appointments to ‘emergency’ patients only, at some point in the last 12 months.

The Pulse survey of nearly 800 GPs found that average waiting times for GP appointments remains at two weeks, despite attempts by the NHS to relieve pressures on practices.

GPs say they have had no routine appointments available for the next four weeks, so have decided to limit them to urgent appointments.

They have had to resort to using telephone triage to identify which patients required a GP consultation for an urgent versus a routine matter.

The BMA’s GP Committee said Pulse’s data was ‘further evidence of the pressures practices are under’.

Pulse asked the question: Have you had to stop taking bookings for routine appointments at any point in the past 12 months?

In all, nearly 17% of survey respondents said they had to reject patients attempting to see a GP for a routine matter. Some 71% of respondents said they had not had to do so, while the remainder said they did not know.

A salaried GP in Cumbria, who wished not to be named, said her practice had been forced to resort to ‘only accepting urgent appointments’, using ‘telephone triage first’, owing to a shortage of GPs.

She said: ‘This was due to lack of GPs. At that time we had only two permanent GPs for a 7,000-patient practice.'

Similarly, Dr Liam Foy, a GP in Derry, said: 'We had an acute shortage of GPs. It was a combination of partners leaving the practice, partner illness and lack of availability of locums.

'We continued to offer urgent appointments and when these were filled we telephone triaged any outstanding requests.

‘We have since managed to secure the services of a couple of locums in the short term and are continuing our hunt for more long term manpower and GP partners.'

But Dr Simon Ruffle, a GP in Reading whose practice has struggled with a shortage of GPs following two partner retirements, said: 'ln some ways having staff shortages made us look at the way we work and so far it seems better, more collegiate and the sick patients are being seen earlier which is safer.'

Meanwhile, Dr Martin Tant, a GP in Lincolnshire, said his practice has permanently stopped taking bookings beyond a month in the future.

He said: 'When we ran out of appointments for the four following weeks, we ceased offering appointments beyond four weeks in the future.

‘We noticed a large rise in patients who did not attend their appointment, having booked this far in advance.'

The situation has arisen despite UK GPs having almost twice the 'safe' number of patient contacts a day (41.5 each day on average, and 60% more than the number considered safe by European GPs).

Health secretary Jeremy Hunt pledged in September 2015 that there would be 5,000 extra GPs in England by 2020 - but the number of full-time equivalent GPs in the workforce has decreased by more than 1,000 since then.

The BMA has called for limits to be agreed for the number of consultations a GP can safely undertake in a day.

BMA GP Committee chair Dr Richard Vautrey said: ‘This is further evidence of the pressures practices are under, with growing demands for appointments not being matched with an ability to provide them due to the continuing recruitment and retention crisis in general practice.

‘Over recent years, the number of consultations has been steadily rising while the GP workforce has been declining. Surgeries are now left in the position where telephone triage is the only method by which staff are able to handle this demand in a safe manner – but this can result in increased stress for many GPs as they try to manage so many patients each day.’

He added: ‘Patient empowerment, better education on public health issues and effective use of social prescribing may go some way to ease demand on general practice. What is urgently needed is proper investment and support from government to solve the workforce crisis.’

RCGP chair Professor Helen Stokes-Lampard said: 'GPs up and down the country are fighting fires, delivering care to patients with urgent health needs - but this often means patients whose problems aren’t necessarily urgent are having to wait longer and longer. Our concern is that a problem might not be urgent initially, but becomes urgent further down the line if it isn’t dealt with - GPs want to identify and treat problems early, so that it doesn’t come to that.

'It’s huge testament to the hard work and dedication of GPs and our teams that more than 70% report not having had to turn a patient with a routine issue away, but for others, there simply are not the consultations to offer, or the GPs to deliver them.'

An NHS England spokesperson said: 'With 33,600 GPs in England, this tiny survey represents less than 3% of those GPs, and, of even those, fewer than a fifth said they have taken this action.

'We understand the pressures general practice is facing which is why the NHS is investing £2.4 bn extra in GP services, growing the number of new doctors entering general practice, and rolling out evening and weekend appointments to patients across England over this coming year.'

Have you had to stop taking bookings for routine appointments at any point in the past 12 months?

Yes - 16.51% (127)

No - 70.61% (543)

Don't know - 12.87% (99)

The survey was launched on 12 April 2018, collating responses using the SurveyMonkey tool. The 28 questions asked covered a wide range of GP topics, to avoid selection bias on one issue. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a Ninja Coffee Bar as an incentive to complete the survey. A total of 769 GPs answered this question.

Average waiting times are based on a mid-point analysis of data supplied to Pulse by 728 GPs via the same survey.




Readers' comments (9)

  • Its the Morale stupid!
    Sort that out ( pay; respect the professional; terms and conditions; GMC induced fear; indemnity; double heapardy; Revalidation; non evidenced based initiatives etc) and voila! Problem solved.

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  • See 6 patients in the morning and 6 noon - 20 mins each to manage eRS, computer glitches, paperwork and all the crap and send the rest to walk in centre where the service is paid anything from 25-50 pounds per patient and NHSE and CCGs are happy to pay them that much. Unfortunately, primary care is not considered to deserve half that funding and that is the problem.
    NHS's managerial morons have to wake up to proper funding of primary care otherwise problems will never resolve.

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  • AlanAlmond

    Yes and patients are increasingly coming in pissed off. Believe me it doesn’t make the few consultations there are available any easier. 3 minutes of a ten minute consultation listing to someone rant about how difficult it was to get their appointment seems pretty routine these days, bringing with it a perceived entitlement to discus 7 problems, and stay with you for 25 minutes - screw everybody else in the waiting room 30% of whom will probably come in with the same attitude, more and more likly the later your clinic runs

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  • For what does a patient need a routine appointment more than 4 weeks hence?
    One practice I know has a DNA rate for 'same day emergency appointments'.
    The further in advance, it seems the more likely to DNA.
    Appointments in the next four weeks are probably for all the 'urgent but not emergency' problems, though patients are taking to booking same day emergency appointments simply because when they ask for something in advance, they are told there are none in the next 4 weeks, 'which is as far as the appointments rota goes on the computer', so ring tomorrow and ask for an emergency one.

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  • A large proportion of patients feel that their appointment needs are ‘urgent’ but this seems to reflect the staggering selfishness of humankind in our part of the world.
    In my experience this only meant that I couldn’t give time to those that genuinely needed it.
    Soon, and I mean very soon, there may not be a service that the selfish ones can complain about even if they have money to pay for it.
    The cavalry isn’t coming and has long gone. Oh yes! With cuts to defence budgets there isn’t a cavalry to come anyway!

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  • AlanAlmond

    There are unfortunately plenty of reasons why a patient may need to book an appointment that isn’t urgent and could certainly be anticipated 4 or even 8 or might I proffer 12 weeks or more in advance, including but not limited to medication reviews, COPD reviews, diabetic reviews, asthma reviews, mental health issues and any number of reviews and the management of non acute chronic health issues. If the only option your patient has is a same day emergency appointment because you are booked up for 4 weeks hence, you really aren’t running a primary care service, more a half arsed second rate first aid / fire fighting / hospital referral clinic. Is that what we think we should be? Urr I don’t think that’s actually what a GP service should be.

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  • Stop triage and spend those minutes seeing the patient face to face. Triage in general practice is a waste.

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  • Regulatory burden, NHSE/ GMC/ Ombudsman bullying, Westminster spin, unreasonable expectations, staff crisis, academic and union divorce from grassroots.... could go on!

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  • Cant believe NHS E response is to dismiss the survey as being unrepresentative, if they think that it does not reflect reality, they are dangerously disconnected from the service they are responsible for commissioning and incredibly incompetent. If they do know that the survey is right and are trying to deny it, then they are deceitful and incredibly incompetent!Either way lots of fiddling whist Rome burns.... As for extended access evenings and weekends, who will be doing the sessions....... the same depleted workforce that cant manage to fully staff the daytime service, that is not going to solve anything.

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