Responding to today’s NHS Appointments in General Practice data for England, Dr Richard Vautrey, GPC chair at the BMA, said: “Today’s figures highlight the immense pressures that GPs and their teams continue to operate under, as they battle to provide care to their communities alongside the ever-increasing workload generated by the pandemic and associated backlog of patients needing care. The data is a stark indication that this is not only an unsustainable way of working, but also that practices – often understaffed and woefully under-resourced - are starting to crack as a result.
“It’s testament to general practice that in April, the majority of appointments were done the same day as booking. The number of consultations taking place after a two-to-seven day wait is going up, which is a sign that practices are responding appropriately to the needs of their patients who want to wait for a specific timed appointment, often face-to-face. However, it’s also a sign that other practices are struggling to meet same day requests, and illustrates the serious toll that increased patient demand is having on surgeries across the country, and how much harder it is for GPs to give patients the timely care they need.
“In fact, recent BMA research found that doctors are suffering ‘moral distress’ and even ‘moral injury’ because they cannot give their patients the care and support they want to when they feel they need it. More than half of the doctors surveyed cited ‘insufficient staffing to suitably treat all patients’ as one of the leading causes of their moral distress.
“The BMA has warned time and again that the problems in general practice pre-pandemic were going to have a knock-on effect during and after Covid-19, and this cannot continue to be ignored. Before Covid-19, patient demand was increasing while the number of GPs was falling, so the much needed solutions aren’t new – we need more staff, more resources, better premises and more support from Government if we’re to avoid an even bigger, potentially irreversible crisis in general practice. The difference this time is that there isn’t any time left, and that ignoring these problems actively threatens the collapse of primary care – and ultimately the foundations on which the rest of the NHS is built.”
To illustrate what these pressures look like, one GP submitted to the BMA a time log of a typical Monday in general practice.
Her day started with administrative meetings at 7.45am before turning to the telephone consultation list at 8.15am. Between 9.30am and 10.30am, she had completed 15 remote consultations, organised face-to-face appointments for four of those patients, arranged blood tests, prescriptions, and helped advise other staff members.
By 12pm, her log reads: “Non-stop phone calls and e-consults, interrupted four times by team members needing me to review urgent ECGs and by reception needing advice on how to manage difficult questions from patients. In total in this 1.5 hours did 10 phone consultations and eight e-consultations.”
The log for the next hour said: “Read 25 urgent letters from hospital specialist teams, patients, and actioned them – more referrals, seven letters back to the hospital reminding them they need to organise their own tests and act on them, sent myself reminders to follow up things related to these, sent text messages to patients to let them know we had results or information, or that I needed to speak with them about the letters. Spoke with four patients who were available at the time.”
Later in the day, she writes: “I did another 15 calls and 18 e-consults, booked face-to-face appointments for the patients who needed them, arranged investigations and plans for other patients, had some really good conversations with patients who are now all sorted or need long-term follow up.”
After advising a district nurse on an end-of-life patient and calling a counsellor to discuss a high-risk patient, our GP left work at the unusually early time of 6pm.
“Left work at 6pm today due to a childcare commitment,” she writes, “but my colleagues were there till 7.45pm. Face-to- face appointments, calls and e-consults were wrapped up by 6.45pm and then they got onto the routine prescription signing, looked at the pathology results that had come in over the day, and checked that none of the letters that our workflow team had allocated to us during the day were urgent. None of us got to our individual tasks with jobs like chasing up results that seem delayed, or writing more complicated referrals, but that’s normal for a Monday - we don’t usually get to those until Wednesday or Thursday.”
Notes to editors
The BMA is a trade union and professional association representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.