Around 60% of GPs say they are able to offer face-to-face appointments to patients with similar waiting times to remote consultations, a Pulse survey has revealed.
A further 22% of the 860 GPs across the UK surveyed said they were able to offer face-to-face appointments to anyone who requested them, but with longer waiting times.
More than half of GPs said that requests for face-to-face appointments had ‘significantly’ increased in the past year, with a further quarter saying they had slightly increased.
The Government, NHS England and the media have focused on GP access since the beginning of the pandemic, with GPs being blamed for patients’ struggles in getting appointments at a time when demand is increasing and workforce numbers are decreasing.
GP respondents to the survey said that they are facing increased demand, but are looking at ways of providing choice to their patients while reducing waiting times.
Meanwhile, many respondents who said they didn’t offer F2F appointments to all patients who requested them explained that these decisions tend to be due to clinical reasons.
The survey revealed:
- 52% said requests for face-to-face appointments ‘significantly increased’ since June 2022, while 25% said they had ‘slightly increased’;
- 16% said they were at similar levels, while 3% said requests had decreased;
- 58% said they are able to provide face-to-face appointments to all patients who request them, with similar waiting times to remote consultations;
- 22% said they were able to fulfil all requests significantly longer waiting times than for remote consultations;
- Only 16% said they were not able to fulfil all requests, though a number of these GPs said this was usually based on clinical necessity.
In that same period, the number of fully-qualified full time equivalent GPs has reduced by 1,400.
Meanwhile, a Pulse analysis earlier this year showed that practices that offered a higher proportion of appointments face to face had longer waiting times and a greater percentage of appointments with non GPs.
Despite this, GPs are implementing systems that offer face-to-face appointments when requested and necessary, while keeping waiting times down.
Dr Brigid Joughin, a GP and recent PCN clinical director in Newcastle, said her average sized practice offers telephone consultations on the day for any patient who requests one. She says: ‘When the GP phones the patient, some will quickly express a preference to be seen face to face and this is usually arranged. We offer all children the choice for face to face without telephone consultation but a significant minority choose a telephone consultation.’
She adds: ‘Many are happy with the telephone consultation and both GP and patient agree F2F will not add anything. Sometimes we think seeing someone F2F would help with management but the patient is reluctant to come in and asks if it’s really necessary.
‘We tend to have a reasonable knowledge of our patients and patient/doctor relationships have been good over many years which I think is very helpful when using this system. We have no complaints about lack of F2F appointments and feedback about the system is generally positive.’
Dr Zishan Syed, a GP in Kent, said that face-to-face appointments are more accessible in primary care than secondary care. He said: ‘There are not infinite resources for general practice. This does not seem to be appreciated by the government and general public. Interestingly the hospital has increased its telephone consultations but the clinicians are not doing the necessary scans and blood tests and routinely try to dump this on to GPs. This is reducing our capacity for our work.
‘We are finding that when we refer patients to NHS hospital outpatient appointments, rather than being provided with a face-to-face appointment a considerable number of patients have been provided phone appointments with lengthy lists of investigations such as scans and blood tests being allocated by the hospital for the GP to arrange.’
GPs are also facing extra workload through patients using private healthcare, and then having tests and treatment through the NHS. He said: ‘This means that GPs are effectively providing numerous appointments to do the work of hospitals and private clinics in the country pro bono. This is entirely unsustainable.
‘This is furthermore compounded by negative media coverage that repeatedly complains about reduced access to GPs. We do not have infinite resources. We have enough of our own contracted work to do rather than being expected by others to do their work for free. This is crushing us.’
Dr John Sharvill, a former GP partner in Kent, said: ‘I am all for F2F appointments. I hate video and telephone consults.’ He said: ‘I could not feel confident in a hot child under five or someone with abdominal pain without seeing them. There was a time when uncertainty was dealt with by personal review, but now it is a case of joining 111 or an A&E queue rather than seeing people. The time it takes me to so a full video consult after preparing the equipment, I could have seen the person.’
Professor Kamila Hawthorne, RCGP chair, said: “Safe, timely and appropriate care can be delivered both in person and remotely. We know some patients prefer seeing their GP face to face, and many GPs prefer this way of consulting, but some patients find remote care a convenient and effective way of accessing GP services. As such, most practices offer a mixed method of delivering consultations – what these survey results show is that regardless of how care is delivered, GP teams are working under intense workload and workforce pressure, and this is impacting on how long patients have to wait to access our services.
‘GPs and our teams are delivering millions more appointments every month than before the pandemic, with more than 43% of these on the day they were booked in June and approximately 70% carried out face to face. This is despite having almost a thousand fewer qualified, full-time equivalent GPs in the workforce than in 2019.
‘GPs are as frustrated as our patients when we struggle to deliver the care they need in a safe, timely and appropriate way. This is due to years of underfunding in our service and poor workforce planning. We need to see the foundations of the recently announced long-term workforce plan laid now, alongside significant investment for hugely improved retention initiatives – curbing the rate at which GPs leave the profession and encouraging new GPs into the workforce.’
An NHS spokesperson said: ‘Every GP practice must offer face to face as well as telephone and online appointments, and patient preference must be considered alongside clinical need, with almost seven in ten appointments being delivered face to face.
‘GP teams are already delivering half a million more appointments every week compared to before the pandemic, and the primary care recovery plan with record investment looks to improve access further through pharmacists prescribing for common conditions for the first time and more options for patients to self-refer, while the NHS Long Term Workforce Plan commits to increasing the number of GP training places by half.’
Pulse’s survey was open between 9 and 15 June 2023, collating responses using the SurveyMonkey tool. A total of 860 GPs from across the UK responded to this particular question. The survey was advertised to our readers via our website and email newsletter, with a prize draw for a £250 John Lewis voucher as an incentive to complete the survey. The survey is unweighted, and we do not claim this to be scientific – only a snapshot of the GP population.
Results in full
Since June 2022, have patient requests for face-to-face appointments: Significantly increased 52.21% 449 Slightly increased 25.12% 216 Stayed the same 15.70% 135 Slightly decreased 2.21% 19 Significantly decreased 0.81% 7 Don’t know 3.95% 34 TOTAL 860 Are you able to provide face-to-face appointments to all patients who request them? Yes, with similar waiting times to remote consultations 58.02% 499 Yes, but with significantly longer waiting times than for remote consultations 21.98% 189 No 16.28% 140 Don’t know 3.72% 32 TOTAL 860
What GPs are saying
‘Patients have remained patient with the service limitations. Small proportion do complain about access.’
‘We do telephone triage for all, but see patients if face to face is needed for an examination.
‘We decide who gets F2F and remote, offering choice if it doesn’t make a difference.’
‘We just can’t meet demand.’
‘We try to persuade telephone or digital if more appropriate- also those frequent attenders we don’t allow F2F with no good clinical reason.’
‘We do not provide f2f on demand: triaging GP has final say. Some who do not ask for f2f will be encouraged to attend. others will not.’
‘We don’t have enough capacity as it is.’
‘We could, but choose to triage.’
‘Not all requests are appropriate, and some can be more efficiently directed, or advised on infection risk and more appropriate management.’