Over the past couple of months, many local people have contacted me with concerns about seeing their family doctor, despite most other aspects of our lives returning to normal. In particular, numerous residents have found it difficult to get a face-to-face appointment with their GP.
Individual cases have been referred to the Clinical Commissioning Group for a specific response; but I want to set out here the work being done by doctors and the Government to improve access.
National plan for GPs
I have been raising the difficulties of seeing GPs for a considerable time in the House of Commons and in meetings with Health ministers. I am therefore very pleased that the Health Secretary has announced a new plan for NHS primary care for the winter. It can be read in full here. In brief it:
- requires GP practices to carry out a review of levels of face-to-face care
- provides £250 million to boost capacity ahead of the winter, opening up more appointments. Some of this money can be used to pay for additional locum GPs, so that more face-to-face consultations can be held
- spreads the workload, so GPs can focus on where they are most needed – specifically, practices will be encouraged to use the NHS Community Pharmacy Consultation service, so community pharmacists can do more in terms of prescribing
Local situation for GP surgeries
In addition to putting questions in Parliament, I have also been keen to gain a better understanding of the situation myself, and so I’ve been to visit some of our local GP practices, to meet the doctors, receptionists and practice managers. I am grateful to them for answering the many questions I asked, and showing me first-hand the challenges they currently face.
The first thing to say is that our local GPs and their teams have undoubtedly been working phenomenally hard over the past 18 months. Indeed, all the local surgeries have told me that doctors are dealing with more patients per day than they were before the pandemic – albeit most of those patients now have their consultations by ‘phone or video.
However, I have been personally assured that if a patient needs to see a doctor face-to-face, they will do so.
Doctors tell me that the key question is “need”. I realise that many of us would prefer to see a doctor in person, but there are a number of reasons why this cannot always be done.
One of the main ones is that GP surgeries are still subject to infection control measures. These mean:
- Social distancing is required in waiting rooms – so there is space for far fewer patients
- Consultation rooms have to be cleaned after every patient has been seen – even including the door handles
- Fresh PPE has to be worn for every patient, and it takes time to change into and out of the required protection
The UK Health Security Agency (UKHSA) is currently reviewing these requirements to assess whether or not they are still necessary, and I understand that it is likely to recommend a more flexible approach to patient consultations. This should make it much easier for more patients to be seen in person.
It’s also worth noting that, as in all workplaces, members of staff are sometimes obliged to isolate and many of the jobs done in a surgery can’t be done from home.
Another reason for the difficulty in obtaining face-to-face appointments is that the number of people wanting to consult their doctor has increased dramatically since before the pandemic. But the number of doctors locally has been falling – a considerable number are retiring, and there aren’t yet enough to replace them. The number of training places has increased substantially, but in the meantime there’s much more pressure on those who are still working.
Booking appointments online
Many surgeries are now moving to online booking.
At surgeries where patients are required to submit an electronic form to request an appointment, the forms are sifted (“triaged”) either directly by clinicians or by staff following a strict process set out by the doctors in charge to determine whether a patient
- Needs to see a GP the same day
- Needs to see a GP, but the case is not urgent
- Can initially be dealt with by a GP via phone or online
- Can be seen by another healthcare professional at the surgery
I have been assured that if a patient does not have internet access, or has difficulties making appointments online, they can still telephone their GP surgery for help.
Changing role of GP surgeries
Many services that used to be done in hospital are now done by GPs – regular diabetes checks are a good example. While this means it is easier and more convenient for patients, it does also add to a GP’s workload.
In recent years, GP practices have developed far beyond being simply the home to a few doctors and a general nurse. Now there are paramedics, specialist nurse practitioners, care coordinators, social prescribers and physiotherapists. This makes it much easier to see the right person to deal with a particular medical condition – and we all need to recognise that it doesn’t always need to be the doctor: in fact, sometimes, the doctor is simply not the right person. I fully recognise that this means a big change in attitude for many of us – myself included!
Reception and support staff
A key point that was repeatedly emphasised to me on my visits is that there is a big team of staff working in modern GP practices. For most of us, the first contact is a receptionist. I spoke to several, and it’s clear that they have been getting a very hard time from frustrated patients. I was reassured that the questions they ask us are all designed by doctors to ensure we get to speak to the right person. I had been very worried that decisions might be being made without any clinical input, but was assured that this is not the case, and that calls and face to face appointments are all organised according to clinical need, with clinical oversight.
Receptionists and secretaries have been going to work throughout the pandemic; they have had to juggle home schooling and other commitments. I know how easy it is to get annoyed with the person at the other end of a phone line, but I was very concerned to hear about some of the abuse that has been directed at reception staff who have been doing their best to get care and treatment for those in need. There is no excuse for abuse to anyone, at any time, and this especially applies to staff in surgeries who are trying their best to help.
Conclusion
None of this is intended to be an “excuse”, but I hope it provides useful context to the current position at GP surgeries. It is abundantly clear to me that GPs would very much like to be able to see more patients face-to-face. They are undoubtedly keen to do everything possible to enable that to happen and I am absolutely sure that the new NHS plan announced by the Health Secretary will make a significant improvement. I will continue to do all I can to help, both locally and in conversations with Health ministers or on the floor of the House of Commons.
