Why is it so hard to see a GP?

Your GP surgeries are working harder than ever to deliver quality healthcare in very challenging circumstances despite what certain sections of the media would have you believe.

Waiting times for routine appointments have increased across the UK, simply due to a lack of capacity, for a number of reasons:

  • Unprecedented demand
  • Chronic Underfunding
  • Recruitment & Retention Crisis
  • Staff Burnout
  • Coordinated Negative Briefings

1. Unprecedented Demand

The NHS is currently experiencing some of the most severe pressures in its 70-year history.

GP surgeries across the country are experiencing significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and knock-on effects for patients.

In addition, GP practices have been at the forefront of the NHS’ response to the COVID-19 outbreak, delivering vaccine appointments whilst maintaining non-COVID care for patients throughout. Much work from hospitals, who are also overwhelmed by demand and underfunding, has been picked up by primary care with GPs having to deal with patients on staggeringly long hospital waiting lists.

(Stats based on official figures for Nov 2021).
The number of standard appointments in general practice has noticeably risen since last month by 4.7 million to 28.6 million.
That’s the equivalent of 43% of the entire population of the UK consulting in just one month!

Excluding the COVID vaccination appointments, that’s 2.3 million more than September 2019, and 2.8 million more including them.

The number of F2F (face-to-face) appointments has increased from 13.7 million to 17.3 million (a 26% increase). F2F appointments now make up close to two thirds (60.8%) of the total. As a percentage of overall appointments:

There were 319,344,626 repeat prescriptions in general practice in the year between November 2020 and October 2021. October 2021 saw 1,088,438 more repeat prescriptions than October 2020.

That’s a yearly average of 48,599, or around 935 per week, per practice.

The average number of weekly prescriptions in October 2021 was up by 272,109 (4.5%) compared to October 2020.

2. Chronic Underfunding

Successive governments have chronically underfunded primary care which deals with approximately 90% of all NHS patient encounters on less than 10% of the total NHS budget.

The UK spends less on health care than many developed countries.

GP practices in England received an average of £155 per patient this financial year, official data has shown. That’s £155 to cover an unlimited number of medical consultations and provide the necessary infrastructure involved in running a practice (buildings, employment of medical and non-medical staff, regulatory governance, insurance, etc.)

The average cost of providing pet insurance for a Boxer dog is £445 per year, with most insurance policies excluding pre-existing conditions and limiting the number of consultations allowed each year.

GP surgeries are not funded based on their activity unlike hospitals who receive a fee every time a patient uses them. They really are an “all-you-can-eat-buffet” of healthcare and have been expected to survive on relatively smaller and smaller amounts of funding despite the exponential increase in workload over the past decade.

While GP Surgeries remain efficient organisations offering astounding value to the taxpayer, chronic underfunding has taken its toll and highlighted the urgent need for adequate NHS funding and for more funding to shift from secondary care to primary care.

3. Recruitment & Retention Crisis

General Practice was already enduring a recruitment and retention crisis with falling numbers of GPs and nurses and record vacancies before the pandemic even began.

Latest figures show a loss of approximately 1800 full time equivalent GPs since 2015.

In November 2021, Health Secretary Sajid Javid admitted that the government would not meet its own target to recruit an additional 6000 GPs by 2025.

Dr Richard Vautrey, outgoing BMA GP committee chair, claimed Mr Javid’s admission that the Government was not on track is ‘long overdue’,  and it would not come as news to GPs or practice staff.

‘The bottom line is we are haemorrhaging doctors in general practice. Whilst more younger doctors may be choosing to enter general practice, even more experienced GPs are leaving the profession or reducing their hours to manage unsustainable workloads.’

Dr Richard Vautrey

A recent survey of RCGP members indicated that 8% planned to leave the profession in the next year, rising to 34% within the next five.

A major study published this summer indicated the number of practices with high GP turnover almost doubled from 14% in 2009, to 27% in 2019.

Responding to a recent publication of England’s GP workforce statistics, Dr Krishna Kasaraneni, BMA GP committee executive team member, said:

Today, we still have around 300 fewer full-time equivalent, fully-qualified GPs in England than we had a year ago, even with the extra 100 on last month shown in this new data. And since 2015, when ministers first began making promises about increasing GP numbers, England has lost the equivalent of more than 1,700 full-time, fully-qualified GPs. For those left, the average number of patients each GP is responsible for has increased by around 300 – or 15% – over the same period.

“Most notably, between September 2020 and the same month this year, more than 900 GP partners have quit or retired.

“While new doctors may be choosing general practice, this is not keeping up with the high numbers of GPs leaving or reducing their hours in the face of unsustainable, unsafe workloads and rising hostility against the profession. Meanwhile, confusing and damaging pension taxation rules that punish senior doctors for working more are a barrier to their ability to provide care to patients – something the Chancellor failed to address in the recent Spending Review.

“Rather than merely recognising that they are way behind their target, ministers must do something tangible about it and take meaningful steps to retain GPs who have spent the last 20 months going above and beyond in the face of the pandemic. They need to listen to and work with GPs on the ground to reach solutions that support family doctors – without doing so they risk losing far more and the situation for patients getting far, far worse.”

4. Staff Burnout

At a time when practices are being shut down at record rates, staff resignations are rising, and over 20% more GPs are presenting with burnout to the NHS Practitioner health service. It is now not uncommon for GPs to report up to 60 clinical encounters per “half day.”

Having successfully delivered over 75% of Phase 1 and 2 Covid-19 vaccines and while remaining at the forefront of covid care in the community, GP surgeries have continues to deliver their usual routine medical care throughout the pandemic, despite what certain parts of the media would have you believe.

GP surgeries simply cannot sustain such an overwhelming workload. It is simply not possible.

Responses from a recent BMA members survey (July 2021; just over 2050 overall respondents) showed:

  • just over half (51)% of respondents said they are currently suffering from depression, anxiety, stress, burnout, emotional distress or another mental health condition
  • of these, one in five (23%) are suffering ‘worse than before the start of the pandemic’
  • just under half (47%) plan to work fewer hours after the pandemic
  • slightly more than two in five (44%) plan to work more flexibly / from home more
  • over one in 10 (16%) plan to leave the NHS altogether.

I was going to break if I didn’t stop – why I have decided to resign as a GP”

Independent 3rd September 2021

The number of GPs choosing to work part-time has been climbing. Although, ‘part-time’ as a GP very often means working over 40 hours a week and a considerable number of additional unpaid hours just to get through the large numbers of appointments, delivering the workload of more than one member of staff and patient follow-up (administrative) work.

Fewer doctors are looking after greater numbers of patients

Insufficient investment in the GP workforce does not prevent patient numbers from rising. In fact, despite there being 1,704 fewer fully-qualified FTE GPs today than there were in 2015, each practice has on average 1,849 more patients than in 2015.

There are now just 0.45 fully qualified GPs per 1,000 patients in England – down from 0.52 in 2015. For the GPs that remain, this means increasing numbers of patients to take care of. The average number of patients each GP is responsible for has increased by around 300 – or 15% – since 2015.

At the same time, the number of practices is also falling. While many practices have entered into mergers, surgeries can also be closed for other reasons, for example:

  • inability to recruit staff and GP partners
  • no longer viable
  • partner retirements
  • CQC closures due to under resourcing.

5. Coordinated Negative Briefings

While hardworking GP surgery staff have worked tirelessly to keep services running for their patients, there appears to have been a coordinated effort to denigrate general practice and to shift blame for various political failures during the pandemic.

To be clear:

  • GP surgeries have been open throughout the pandemic. They were instructed by NHS England to shift to an online triage system to reduce the risk of infection to patients and medical staff alike.
  • NHS England has continued to insist that a proportion of appointments be delivered to patients remotely.
  • The number of standard appointments in general practice has noticeably risen inexorably over the past 18 months.
  • Last month alone (Oct 2021), appointments delivered rose by 4.7 million to 28.6 million. That’s the equivalent of 43% of the entire population of the UK consulting in just one month!

GPs were not furloughed and many GPs have cancelled annual leave, worked evenings and weekends, over and above their usual hours, just to maintain services for their patients and deliver the bulk of the Covid-19 vaccination programme.

GPs and practice staff have endured physical and verbal abuse from patients who have been fed the narrative that GPs have been lazy and hiding behind closed doors for the pandemic. Nothing could be further from the truth.

For many, the media onslaught and negative government briefings have been too much:

We delivered, at short notice, 75 per cent of a mass new vaccination programme. We dealt with the backlogs resulting from cancelled secondary care work. Data from NHS Digital confirms, contrary to the reports of being closed, general practice was and is busier than ever before. Despite this, we are being shouted at by patients frustrated with delays, and being vilified by large sections of the press. This all takes its toll and GP suicide rates are now four times the national average.

I didn’t go into medicine to defend myself against untruths that general practice has been closed for 18 months (we really haven’t). I’m trying my best and working my hardest to advocate for patients in a chronically underfunded system. If I was able to simply do my job and focus on practising medicine, I could do it. But we are bombarded with so much more than clinical care on a daily basis. Then after a 13-hour day, returning home to see social media comments about GPs refusing to see patients when you’ve just seen, spoken to, or messaged 80 in that one day alone.

Rosie ShireIndependent 3rd September 2021

December 2021