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Pressures force GP practices to halt routine appointment bookings

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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.