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GPs buried under trusts' workload dump

Prominent MP criticises ‘frustrating and ineffective’ GP appointment systems

A former challenger for Labour leader has publicly criticised GP practices' systems of allocating appointments to patients, calling them ‘frustrating and ineffective’.

In a series of posts, MP Owen Smith - who unsuccessfully challenged Jeremy Corbyn for the Labour Party leadership in 2016 - highlighted his own difficulties in securing a GP appointment through what he called the 'telephone at 8.30am and try your luck' system.

While this way of managing appointments may be effective for GPs, it does not work for patients, he argued.  

But GPs were quick to point out the issue stems from a lack of Government funding for general practice and 'cuts elsewhere in society', and argued it is up to the Government to fix the problem, not GPs.

Writing on social media last week, Mr Smith said: 'We have to get our GPs to change the systems they use to allocate appointments. It’s almost impossible to get an appointment with mine (they’d all sold out by 8.35am today) and I know that’s a situation experienced by millions in Britain. No wonder A&E fills up.'

In another post he said: 'To all doctors on my timeline, in light of my pointing out how hard it is to get a GP appointment, I agree (a) nine years of cuts are part of the problem, (b) there aren’t enough GPs and (c) demand is spiralling.

'But not all surgeries employ this “telephone at 8.30am and try your luck-style” of appointments system – but lots do in my patch. And though it may manage demand effectively for the GPs, it is both frustrating and ineffective for patients.'

In response, Nick Steele, a GP partner in Stockton-on-Tees, said that there is ‘no magic bullet’ to fix this longstanding issue.

He said: ‘Many GPs use different systems to allocate appointments and in my experience, as with many other people, whatever system we employ gets filled up because ultimately we don’t have an unlimited number of GPs. 

‘It’s classic politicians making capital out of GP appointments when we’re under resourced. Increase in funding tends to go to secondary care first [while] primary care is neglected.’

Earlier this month, health and social care secretary Matt Hancock told Pulse some of the extra £4.5bn funding for primary and community care will be used to relieve pressure on GPs, however details on this are still lacking.

Tower Hamlets LMC chair Dr Jackie Applebee agreed it can be frustrating for patients who struggle to get a GP appointment, but argued it is not up to GPs to change this.

She said: ‘It’s not for us to rearrange the way we do it. It’s [up to] the Government to funds us properly [to ensure] we’ve got enough GPs to offer enough appointments to meet demand. 

'In my opinion, there’s nothing wrong with the traditional model of general practice. If we change our system, it has to be because of clinical effectiveness and not because of financial pressures.'

'Of course we should be trying to educate patients on certain things they don’t need to come for but when there are cuts elsewhere in society, such as advice centres, then we’ve got people coming with housing issues. People come to us as a first port of call because we’re easily accessible and we’re there,' she added.

A Pulse survey in May found one in six GPs have resorted to stopping routine bookings and limiting appointments to ‘emergency’ patients only, due to increasing pressure.

Readers' comments (29)

  • AlanAlmond

    This comment has been deleted

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  • Spot on AA.

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  • Smith's party created this disaster back in 1947, perhaps he should apologise.

    ps. Fiona Onosanya is the eighth Labour MP convicted since 2010, Labour increasingly the party of the dim and the criminal.

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  • If the pontificating rectal wash-rag called Owen Smith really needed an appointment for something which he deemed important enough to expend some effort to secure, he could have got his ass out of bed and got himself down to the Surgery to secure an appointment.Imagine you were lobbying for Pfizer, you malevolent clueless worm.

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  • " I am extremely cross that I haven't cooked myself any dinner."

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  • Dear Mr Smith,
    Perhaps you should check the facts against your
    perceptions. The latest stats taken directly from GP appointment systems before any refinements that informaticians such as I would apply show your comments to be untrue. In addition the very widespread research on A/E attendance rate has shown on many occasions to not be related to access to GP appointments but to football matches and national soap programming as well as annual event film schedules.
    In short - get your facts straight before you release them to the media.
    Shame on you Pulse for promulgating such nonsense.
    Regards
    Paul C

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  • The "phone at 8.30" system is stupid. It is frustrating for patients and counter productive. There are better systems for coping with demand.

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  • Jobbing GP criticises frustrating and inefficient MP's appointment system :
    To book an appointment with Owen Smith one has to telephone or email sometimes WEEKS in advance ( so they can vet the appointee). There's no turn up and wait system and he's only open for 2 hours once a week.

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  • 1 Owen Smith
    why don't you sort your own shit out first?
    Try getting into power and then providing the investment needed. We can't provide an appt for anyone who needs it every day

    2 @anonymous ex-GP
    What are the better systems for coping with demand? I'm anxious to know, but particularly from someone who is a working GP.

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  • He probably thinks that if he's seen 8 constituents in 2 hours its been a really busy MP surgery.

    We should get some management consultants from Pfizer in to sort it out.

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  • National Hopeless Service

    Dear (not actually) prominent PM and dear Anonymous ex-GP (leaving didnt help GP numbers),If i go to Tescos are there are 25 tills open I get served very quickly, if there are only two tills open I get served slowly and briskly. Its simple bloody maths you idiots.

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  • This morning I am a bit pi**ed at 'frustrating and ineffective ' politicians.Ah well such is life.

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  • CENSORSHIP?

    ok i don't know the ins and outs of MP Owen Smith..
    but as a GP.. i must say
    in a lot of areas
    this appointment system is just awfull

    I guess you only realise when you are a patient yourself or when a family member is unwell


    lets say you need to contact the practice
    as an agency or as a locum
    lets say if you are stuck in traffic
    forget about it the main line is engaged
    you are in a cue
    are you happy to hold

    Yes Agree
    Best job is to physically walk in as soon as they open and book

    its really frustrating as a GP
    when you could quite easily deal with your families simple medical problem
    or prescribe for them
    but under GMC guidelines are unable to do so

    Many places are running e consults and phone triage
    The profession and royal colleges must do something
    and enforce it under CQC
    Otherwise really do not winge when babylon takes up the slack

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  • This MP in his wisdom should understand that I have 3900 patients and get paid for 3380 only - for full service including home visits at 89.50 per year which is £77.50 per patient per year.
    The local OOH Provider charges Practices around £128 pounds per home visit if a GP is not able to do one during my core hours !!
    What does he expect for £77.50 per year !
    There are morons and morons - and this kind of GP basher is the worst as does not realize how immoral and discouraging it is for overworked professionals already pushed to limits.

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  • 20% of our workload results form other providers - get them to their bit - esp as they have had all the funding - let patients self refer for certain things and stop needing a GP referral or signature for everything!

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  • Problem is not managing peaks and troughs it is a lack of total capacity due to the natural well demonstrate effects of communist economic models.
    A plastic bag is cheaper at the point of use than GP time in the UK.

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  • Spot on Unscepted. You get what you pay for.

    80-110 £ / pt / year including LES/ QOF depending where you are in country is less than people pay for their dog and cat's insurance.
    Unfortunately this is what will people get in free for all NHS. If politician really want to improve things let them fund the system properly. Why don't GPC/BMA make publish it in national media?
    How they fund the NHS it is not our problem. It's theirs.
    We will provide service depending upon what it pays for. If government wants to increase funding to double what it is now i am sure we will be able to attract more doctors and provide better system. If government wants people to pay part of the cost, let them say it public . Its not my Job.
    I am doctor not a politician

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  • There is no doubt the current system isn't helpful. But why?

    1) We cannot do unlimited work with limited resources. If we remove either one of them i.e. define how much work or change to payment by activity, you'll see an immediate improvement (and NHS will collapse overnight)

    2) Evidence suggests 20-40% of GP work does not need health care at all. Our residents are creating their own problem by using state resource. How many times have we seen "cough for a day, wanted to be check before going on holiday"?

    3) 40% of GP work is now paperwork due to government policy - may be cut this down and we can see more patients?

    4) under resourced = less admin, less clinicians to provide quicker convenient service. May be Mr Smith needs to think about this?

    5) With the workload, most GPs don't have the space/time/resource for "innovation" to improve their practice. Do you blame them? I called home at 18:30 yesterday to say I'm coming home and I got the reply "oh, you are leaving early today"

    6) And with yearly changing contract and evershifting government policy, who would want to invest in their practice to make improvement? Only those who are willing to capitalise from their patients will invest as state money is too poor to have any return

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  • let him run open surgeries from 0800 to 1830 5 days a week and find ?why can"t we get anybody to be a MP anymore?

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  • little MP got cross because he didn't have priority access for his "needs"
    no thought for the funding crisis and the dying profession - just himself ( but uses "millions" of others to back his cause)
    under the Labour government in 2003, £90 million was pumped into improving winter access to urgent community care- £88 million vanished into the hospital sector without any effect

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  • I understand Mr Owen Smith’s frustration as I was in a practice for 34.5 years until 2 years ago.
    I tried very hard against the odds to triage all the requests for appointments and this worked reasonably well
    Unfortunately the practice was drowning under locum costs and escalating demand from both patients, the CCG and NHS England
    I won’t even bother to mention the extra work and aggravation of the CQC
    Funding has dropped despite fewer GPs and increased costs
    I am sure most GP practices would love to offer a Rolls Royce service but with the government strangling general practice the situation can only be improved by more realistic funding and support both financial and workload for the existing and future GPs

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  • I think this is what frustrates me the most about politicians. They really are too stupid to see its their fault and their responsibility to fix the problem of lack of GP availability. What an idiot

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  • Ineffective because of all the rules creating the toxic climate, lack of funding and staff as well as them stoking up dubious health schemes/checks. In Australia you get 45 min per patient, we only get 10 min and we are expected to give "best care" and yet we are deemed ineffective. Government greed? Sorry, not going to be "more effective" and end up getting Gross Negligence Manslaughter charges equivalent to stabbing someone intentionally.

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  • Alan Almond, my kind a guy, only such harsh words can ever trigger a stimulus, I tell my professional lot what a bunch of fucking idiots they all are, and I am talking GP colleagues here. Yes they are as much to blame. Its not just patients and politicians a lot of our own colleagues are a bunch of pathetic, selfish, faceless A,,,holes and are also to blame for whats gone on for wanting to do nothing about it. Funny they are the ones that do 2 sessions full time in their large practices and then you see their name in the locum list as well or they are arse kissing with their roles in the CCG actually getting paid for doing nothing. Lead this lead that, as my patients jokingly often say, I too say 'why kiss my batty man'!!!

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  • There is a very obvious answer which is in widespread use. Open access just turn up and wait surgeries for acute problems. Watch your patient satisfaction results shoot up, save lots of money spent on paying re eptionists to say no. Know that your patients acute problems can be treated promptly and sleep well at night.
    We used to do this in my former practice but had to stop it on the orders of the NHS area team!

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  • Well said Nick Steele - considered and wise words.

    Capacity exceeded by demand has no quick fix.

    Politicians can help by engaging in constructive debate -knee jerk postings on social media after a poor experience are unhelpful and they can be demoralising to hardworking professionals and staff in our surgeries.

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  • There is a quick fix.

    Charging ten pounds to book an appointment would solve excess demand overnight.

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  • As devil's advocate, is it not our problem that we accept an unlimited Contract? If we accept a contract that should provide timely appointments, then we cannot close appointment systems at 0835 as full for patients [ forget Mr O is a MP, he is speaking as a patient]
    We should accept appointment based Contracts ie say a GP provides so many a day/ so many a year.
    But time after time, this is voted down in BMA ARMs, and we GPs accept this crazy contract, where appointments per patient year has doubled in 15 years and funding has fallen in NI for example from 80 to 60 pounds per patient year.
    Since the BMA accepts this unlimited Contract and we GPs do not wish change, then we can hardly blame patients for increasing consultation rates due to multi morbidity, ageing and shifting secondary care work to primary care.
    Change the Contract or provide what it says.
    By the way, I am a working GP.

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  • the Politicians arent stupid, they have to balance the books. They know that better health care costs money, but they haven't the money.

    So here we are, its us who dont push back....the patients expect a lot because we arent maent to temper their expectations, otherwise NHS England/GMC would be after us. go figure.....

    meanwhile eltlets not complain about our rate of pay less than an OOH plumber.

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