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GP appointment demand ‘outstrips’ capacity, NHS England admits as GP leaders call for change

by Costanza Potter and Beth Gault
10 October 2022

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Demand for GP appointments is at record levels and ‘outstrips’ capacity, NHS England’s board has admitted.

It comes as the BMA and Institute for General Practice Management (IGPM) have both called for a change in how practices manage their workload, including ‘deprioritising’ aspects of their day-to-day activity.

Papers released for a board meeting last week revealed that NHS England will look into running a ‘high-profile communications campaign’ to educate patients on key changes such as the use of additional roles staff.

document on ‘Access to Primary Care’ said that ‘demand for primary care services has never been greater’ as the NHS emerges from the Covid pandemic.

It added: ‘Capacity in some areas, especially in rural or more deprived locations, is stretched and demand is outstripping supply.’

The document pointed to a 35 million increase in GP appointments in the 12 months ending July 2022 compared with the 12 months ending July 2019 – up from 310 million to 345 million.

Speaking at the board meeting, national director for primary care Dr Amanda Doyle said: ‘We’ve got a mismatch in the demand from patients and the workforce capacity available to meet that.

‘We need to address that workload – the workforce we have are feeling overwhelmed and therefore are less likely to stay and to stay full-time.’

The NHS England board also recognised the need for greater retention of GPs, admitting that while there has been increased recruitment of trainees, the number of fully-qualified full-time-equivalent GPs continues to fall.

Dr Doyle pointed out that even as GPs go through training, ‘at every step along the way there is some attrition’.

And she added: ‘Equally important or more important [than recruitment] is retention, we are losing qualified general practitioners faster than we can replace them.’

Board chair Richard Meddings added that the numbers of fully-qualified GPs is ‘actually flat to down’ and that this is a real challenge.

Meanwhile, the document added that over the coming month’, NHS England will ‘explore the feasibility of running a high-profile communications campaign to help raise awareness of some of the key changes that have been introduced into primary care during the pandemic’.

It said this could include the use of the wider multidisciplinary team, community pharmacy and digital routes to contact general practice.

‘Urgent action’ needed

However, the BMA and IGPM have called for greater action, with the BMA suggesting that general practice is in crisis and must prioritise care and ‘deprioritise’ other aspects of their day-to-day activity within the confines of the GMS contract.

The BMA’s safe working guidance, published last week, suggested that the contract only states practices need to provide an ‘assessment’ of patients with emergency or urgent problems, and they can direct them to emergency departments, 999 or NHS 111.

Those who are able to wait should be placed on a wating list ‘if safe capacity is reached on the day’, in order to help practices deal with the pressures they are facing.

It said: ‘Demand for appointments is outstripping capacity to such an extent in general practice that we advise practices to move to a waiting list system.

‘There has been a drive towards near-immediate assessment and management of all problems irrespective of actual clinical urgency and this is simply impossible, and not contractually required within GMS.’

It added: ‘Secondary care has waiting lists based on clinical need and this approach should be adopted in general practice, even if it means that patients with non-urgent problems may wait a number of weeks for an appointment.’

The IGPM said it fully supports the BMA’s statement on managing workload in practice.

It said: ‘Trying to find the balance is becoming an impossible task for managers working in general practice and we stand by our clinical colleagues in asking the government for support to address this problem.’

It follows study findings that ‘inaccurate and unfair’ negative media coverage of GPs in UK newspapers is ‘contributing to workforce stress and the retention crisis’.

The NHS England board papers and meeting also revealed that:

  • NHS England is looking at how we develop integrated neighbourhood teams, as recommended in the Fuller stocktake and recently backed by the BMA
  • One of NHS England’s key priorities is taking ‘immediate action’ to make it easier for patients to get in touch with their GP practice as patients are struggling to access services because they cannot through on the phone
  • It will also look at making it easier for patients to directly book  appointments via the NHS app and online
  • NHS England is working with the Government to address visa issues for international medical graduate GP trainees
  • It is also working with the Government on pensions flexibility to stop ‘perverse incentives’ for GPs to retire earlier
  • Repurposed PCN incentive scheme funding can be used for additional appointments and capacity to support provision of services based on local need, such as respiratory hubs.

Part of this story was initially published on our sister title Pulse.