Have waits for GP appointments got longer?

By Caroline Parkinson
BBC News

Image source, Getty Images

How long do you wait to see your GP?

Members of the BBC NHS Health Check Facebook group report waits of three weeks or more are common.

Lisa Johns said: "Ours book five weeks ahead. For the last three weeks, I've been trying to book a standard appointment and can't get one, as they go in seconds."

Another member posted: "I booked a non-urgent appointment with my GP last week.... for 22 January 2019."

Their experiences are backed up by statistics.

Earlier this month, NHS Digital published figures showing that, while 40% of patients were seen on the day they booked, just under a fifth waited longer than a fortnight for a routine appointment with a GP or practice nurse.

But what's the story behind these figures?

Have waits actually got longer?

The NHS Digital figures show of 307 million appointments booked at practices in England between November 2017 and October 2018:

  • 40% were on the day
  • 27% were within a week
  • 14.5% were in one to two weeks
  • 8% were in two to three weeks
  • 5% were in three to four weeks
  • 5% were in more than four weeks

It is the first time such figures has been published - so there aren't similar figures to compare them with. But plenty of previous research has found demand on GP services has grown. And experts say they do see waits increasing.

Prof Helen Stokes-Lampard, head of the Royal College of GPs, said: "This is a real problem. It's something we predicted. Unfortunately, it's the inevitable consequence of a shortage of GPs."

A 2016 Lancet paper said GPs' workload had risen by 16% in the seven years up to 2014, with more frequent and longer GP consultations.

Is it because demands on GPs have increased?

Factors including an ageing population and an increasing number of people with complex medical needs mean the standard appointment often isn't long enough.

Dr Kamal Mahtani, a GP and an associate professor in primary care at the University of Oxford, said: "You've got 10 minutes to talk about their diabetes, their high blood pressure, their mood and look at the patient more holistically.

"So a GP might end up having to say, 'We've dealt with X and Y today but I'll need to see you again.' And that has a knock-on effect.

Image source, Getty Images

People were directed to their GP for lots of different things, he said. "If you're not feeling well, go and see the GP. If you need a flu jab, go and see a GP - as if we're a one-stop shop."

But the RCGP said a lack of GPs was also affecting availability.

"We're now 1,000 short of the number of GPs we had when they promised 5,000 more - so now we're looking for 6,000," an RCGP official said.

Is it safe to wait weeks for an appointment?

Some patients are happy to wait. They might want to see a particular GP whom they know or someone who is familiar with their long-term health problem - it might be something that isn't going to alter over a few weeks.

But there are fears that others might be at risk from waiting.

Catherine Churcher, another member of the BBC NHS Health Check Facebook group, was concerned that the most vulnerable would be least able to negotiate the system and so be worst affected,

"There must be lots of people out there who are falling through the net and not being seen because they don't have the strength or fight in them to go up against the current system," she said.

Prof Stokes-Lampard said: "There's no hard data that shows patients are coming to harm. But that's my profound concern - that there are things that will be missed."

And Dr Mahtani said: "How do you know if the patient's condition isn't getting worse if patients are waiting three weeks? I can't tell you that they're not suffering until I see them.

"And there's always that risk that the longer waits are causing harm."

Are all practices affected?

No - but Prof Stokes-Lampard warned that even if your practice seemed OK, it was still vulnerable to events at neighbouring GPs.

"All you need is for the practice down the road to close and then patients would be moved and your practice would be under pressure," she said.

"There is a domino effect. And then it's phenomenally stressful for the doctors at that practice."

Is there anything that will help?

GPs say patients can help - by calling in if they can't make an appointment, so it can be freed up for someone else, and by thinking whether they could get the advice they need somewhere else, such as the chemist's or dentist.

There are various ideas being tried out across general practice too, experimenting with taking some of the administration away from GPs and bringing in other professions, physiotherapists and social workers, into primary care in addition to the specialist nurses that many people are already familiar with.

Technology can also help - some practices have online systems where patients can book directly.

But Dr Mahtani said there was no single solution - because each practice had a different mix of patients and different skills among its staff.

Better funding was key though. "If you invest in primary care, you will reduce your costs in secondary care - 90% of first contacts are in primary care," he said.

"We need to embrace general practice."

What's your experience of booking a routine appointment with your GP or practice nurse? Join our group and let us know.

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