General   (General discussion, talk about anything.)

Dr Mark Porter today’s Times.

Can’t get an appointment with your GP? I have a few tips
As many patients struggle to get past telephone consultations and online requests, Dr Mark explains why it’s so hard to get seen by a doctor and the best course of action to take when you become ill

Dr Mark Porter
Monday November 13 2023, 5.00pm, The Times
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Arecent survey of older people’s experiences accessing GP surgeries had me squirming in my seat this morning. And this quote from the director of the campaign group Silver Voices, who commissioned the survey, was the trigger for my discomfort: “The family doctor is becoming an elusive species, with many hoops to be negotiated before an audience is finally granted to the patient.”

Three quarters of the 1,200 people surveyed said they found it difficult to get a face-to-face appointment with their GP, with most being offered telephone consultations instead. Faced with hurdles such as holding while waiting for their call to be answered or being asked to submit their request online, many gave up and sought alternatives: one in five said they had resorted to their local emergency department, while one in three said they had booked to see a private GP. So what has gone wrong?

I do not, and you certainly don’t, need a survey to know that it is difficult to get an appointment with a GP. My practice has historically had one of the highest patient satisfaction scores in England, and we pride ourselves on seeing all urgent cases the same day, but we are slipping. We can still cope, just about, with urgent requests, but over the past few years waits for routine appointments have gone from a few days to a few weeks.

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I can’t speak for every practice, but our biggest problem has been demand. I don’t want to bombard you with data but it is important for perspective. Suffice to say that GPs are not being intentionally elusive (well, the vast majority anyway), rather they are drowning under an ever increasing workload. Before Covid, GP surgeries in England completed about 25 million appointments every month. In September this year that figure had risen to 31 million (32.6 million with Covid vaccines).

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And, contrary to what you may read or experience, most appointments are still face to face (71 per cent in September). GPs deal with about half of all appointments and nurses about a quarter, the rest being with healthcare assistants, counsellors, paramedics, pharmacists and other members of the team. And four out of ten consultations are completed on the day that the patient requested one.

As timely appointments become harder to get, people will inevitably look elsewhere, but GPs still see about 20 per cent more people in a month than emergency departments (EDs) in England see in a year. However, it doesn’t take much to overwhelm local hospitals, and that alters perception too. Think of patient demand as water, GP surgeries as a bath and EDs as the bathroom floor. We do about 360 million consultations a year while EDs do about 25 million. So when the bath overflows even a tiny bit it floods the floor.

There is no single reason behind the recent rise in demand. However, factors include record waiting lists at hospitals, meaning people can’t get the operation or treatment they need so depend more on their GP to keep them going, and the challenges of an ageing population with multiple issues that require constant input (about half of the hundreds of blood tests we do every week are for monitoring long-term conditions).

At my surgery we have tried all sorts of things to make it easier for patients to book in. Most appointments are made on the phone, but you can book routine ones online or using the NHS app, or walk in and do it in person. Nearly all urgent requests require a telephone consultation first to assess what needs to be done and when. And non-urgent requests can benefit from this triage.

Take a 40-year-old woman who over the past six months has felt run-down and more breathless when she exercises. Questioning during a triage phone call reveals that she has very heavy periods and is a vegetarian. She needs to be seen, but it would be a more efficient use of everyone’s time if she had a blood test to check for anaemia first so she can be seen with the result and everything completed in one face-to-face GP appointment.

All of which is great in theory but of little consolation if you are No 10 in the queue waiting for someone to answer (see below). Our record for one day is more than 800 calls to reception at a branch of our practice that has more than 6,000 patients. I know it’s frustrating, but when we open another line or employ another receptionist, as we have done, we get even more calls.

Meanwhile, “out the back”, a typical day for me starts at 7.30am and finishes at 6.30pm with brief breaks for a pee, a quick coffee, lunch at my desk and a home visit or two. Be reassured I am not hiding in my room reading a book or scrolling through my phone. I am not after your sympathy, just some understanding that your difficulties are not solely because doctors are an elusive species. They are a dwindling one, but that’s a subject for another day.

The GP’s guide to getting help
Booking systems vary across practices, so it is hard to generalise, but these tips may help to ease the booking process at surgeries that use a mixed system like mine:

• If you want a routine appointment — for a problem such as a longstanding arthritic knee, or to discuss HRT — do try to use the NHS app or online booking system if your surgery has one
• Alternatively try calling outside the busiest periods (8am to 10am and 2pm to 3pm at my practice). Waits will typically be two weeks or more
• If you feel your problem is urgent don’t feel fobbed off with a call back from a GP. It’s typically the fastest way to access care, and I often tell people to come straight in once I have triaged their request
• If it is very urgent — such as chest pain or a suspected stroke — don’t call your GP. Dial 999
• No matter how ill or angry you are, please don’t take it out on the receptionist. They are under a lot of pressure, and being polite is more likely to get you what you want
• Last, if offered an appointment please turn up —one in ten people didn’t in September — or call to cancel so we can offer it to someone else