Practices losing 200k appointments each week due to GP online access changes

Exclusive GP practices are spending time equivalent to more than 200,000 appointments a week implementing new online access changes, which is increasing waiting times for patients and working hours for staff as a result.

GPs and practice managers have said that recent contractual changes have forced some practices to cancel appointments to protect time to go through the requests, while some have had to extend staff hours, a Pulse and Management in Practice survey has revealed.

This is a direct result of changes brought in on 1 October that require practices to ensure online requests can be submitted between 8am to 6.30pm.

Last week, Pulse reported that GPs were warning the new requirements risk compromising patient safety, with patients reporting breathing difficulties, severe vomiting, acute abdominal and chest pain, and rectal bleeding through online forms.

The survey of 431 GPs and practice managers – encompassing 412 practices – found the average GP is spending around 53 minutes per week on implementing the changes, while non-GP clinical staff spent 42 minutes on average and admin staff 31 minutes. 

Projected out to the entire full time equivalent (FTE) GP workforce in England (38,860), this equates to over 34,000 GP hours each week, or 209,442 10-minute appointment slots.

The BMA has formally entered a dispute with the Government over the changes, warning that many practices would struggle to implement the changes safely and would have to introduce waiting lists.

In all, 93% of survey respondents said their practice had implemented the changes – up from 60% before 1 October – with 47% seeing waiting times increase as a result. Just over a third (36%) said they were able to clear all late online requests on the day. 

Common measures for dealing with the changes reported by GPs included blocking appointments to create space for triaging (58%) and extending staff hours (43%).  

And 77% of GPs said their practice would continue to close for half-day training, with only 4% reporting they had stopped them because of the contract changes.

A GP in Cambridgeshire said the changes have made their practice ‘feel even more like a production line’. 

They said: ‘The GP day, which was previously already “full on” – grabbing lunch, difficult to find time even to eat, debrief registrars or go to the toilet – has now become even more relentless.  

‘How sad to feel even more like a production line. Quality general practice needs time to pause, evaluate, reflect, contact patients about abnormal results, check in on cancer or palliative patients. 

‘With all inputs on, all of the time in the day, the quality of care in other areas will reduce as we can’t fight fires and plan holistic medical care for vulnerable patients simultaneously.’ 

One Merseyside GP said they both partners at their surgery are now working very long hours to prevent next-day backlogs building up. They said: ‘I stay in the surgery until I can’t think any more, some days that’s been 10 or 11pm’. 

Many GPs reported significant cutbacks in the number of available appointments and GP sessions due to implementation requirements. 

Surrey GP partner Dr Dave Triska said his practice has seen an approximate 15% increase in online submissions since 1 October, despite his practice continuing to turn off the tool in the middle of the day to protect time for receptionists to phone patients.  

Dr Triska said the increase in expectations of immediate access is like ‘trying to fit a pint into a thimble’ given the realities of GP practice capacity to deal with requests. 

He said: ‘The current mitigation in a system that is sensible is that you absolutely have a human review for this, a clinician review, ideally, because at least then you can do that with the voice of experience rapidly.

‘But the operational problem is that you physically can’t do that in practice, from 8am until 6.30pm in the evening without significant denigration of services, or indeed the person providing that service.’  

Another GP said: ‘We previously had phone lines off between 12.30 and 2pm (emergency line open) to allow reception staff to crack on with referrals and prescriptions.  

‘Having them turned on has been terrible and staff are burning out already as (there is) no time to do the admin work. We are a small surgery with limited space.’

A Department of Health and Social Care spokesperson said: ‘This data only represents a very small percentage of GP practices. Patients want this service, with more people now contacting their GP online than by phone, and we gave practices six month notice to prepare for the rollout.

‘We are grateful to the majority of practices are already delivering this service successfully – to the benefit of patients and their care – and we are supporting others to increase compliance.

‘To support GPs, we have also provided an extra £1.1 billion of vital funding and have recruited 2,500 more GPs.’