UPDATE: |This is why you’re waiting weeks to see your GP News

‘None of us want to be in this situation’, admitted the Greater Manchester doctor

There has been a crucial change in the way many GP surgeries hand out appointments in recent years – and it’s the reason patients might be left waiting weeks to see their doctor.

One leading Greater Manchester GP has explained how appointments work at her practice, sharing just why so many people have seen routine appointments being scheduled further and further in advance. Dr Helen Wall, a GP partner in Bolton, said the Covid-19 pandemic created a fundamental shift in the way GP surgeries operated, and a knock-on change in demand from patients to be seen the same day.

“During Covid, because we were ringing a lot of people and saying come down now, we created this thing where people wanted an on the day or next day appointment they perhaps wouldn’t previously. But it’s just the way we were working because we were triaging everybody [before they came into the surgery to comply with infection control measures],” Dr Helen Wall explained to the Manchester Evening News.

“Now we ringfence a lot of our appointments so that they can be done on the day, which means there’s not as many of our routine appointments. So you have to wait longer.”

Operations differ from practice to practice, as GP surgeries run as individual small businesses. Every GP surgery has an NHS contract and has to supply certain services, but how those services are provided can depend on the leadership of the partners, the workforce, and the resources available.

“At my practice, we do get asked a lot why our routine appointments are so far in advance and all I can really say is if you are really ill and we really need to see you, then we will see you much sooner. We don’t turn anyone away,” continued the doctor.

“We don’t do that 8am rush, where everyone calls at eight and if they’ve not got an appointment by ten past then they just have to find somewhere else. If you ring on that day and you are unwell, we will see you.

“But the consequence of that is we have to ringfence a lot of the appointments for on the day availability, so our routine appointments get further back.

“If we weren’t to do that, then we may well have to operate the system where we say ‘everybody ring at 8am for a same day appointment because all the rest of our day is taken up with routine appointments, so you don’t have to wait that long for them’.”

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But, ‘none of us want to be in this situation’ where there is constant push and pull between routine and same-day appointments, says Dr Wall. “Primary care now is doing more appointments now than it ever has. The stats speak for themselves, we’re having more patient contact, more appointments a day than we ever have, including pre-Covid.

“But we’re never on top of it and we feel like patients are never happy with the offer. So clearly something’s not lining up right.”

Demand on GP services was already rising before the pandemic, exacerbated by treatment delays and surgery backlogs because of multiple lockdowns. But an increase in digital access has also sent demand skyrocketing, says the doctor.

“In general practice, we’d already been asked to look into doing things like online consultations, text messaging and digital access before the pandemic began to help respond to increasing demand. When Covid hit and we were asked to close our doors, all of that just suddenly got expedited,” said the GP.

“But as we’ve gone digital, we’ve become more accessible. By trying to fix the very problem that we were struggling to cope with – demand – we’ve increased it.

“People contact us now for much more minor things than they would have done previously, because they can fill an online form in or they can do something digitally, reply to a text message.

“We had online consultations during Covid and people would send us an online medical form at 3am and say they had a sore toe. Then when you would call them at 11am, they’d say, ‘well, it’s better now. I forgot I even sent that in.’

“The fact that people can ring us, have an appointment while they’re at work during the day means that they’ll just get one just in case. Whereas before, they might have not taken an afternoon off work unless it was something that was really serious, or really bothering them.

“It’s Amazon Prime culture. You can, so you will.

“Once people become used to a certain level of access and service, how do we ever go back from that? It’s like saying Amazon Prime finishes today and you’re never going to be able to get your parcel the next day again.”

The pressure on GP services, and the ‘understandable’ frustrations patients direct at NHS staff, is driving doctors away from the NHS – only feeding demand-capacity problems. Limited NHS funding, along with the upcoming rise in National Insurance paid by employers, has meant practices cannot afford to hire new GPs to meet that demand.

That has even left some GPs out of work, says Dr Wall.

“We’ve got a lot of people who are fed up of waiting for everything, they’re fed up with feeling like they’re not getting access to what they need,” says Dr Wall.

“We get that because we’re all patients as well. I think patients often forget that, they think that because I’m a GP, my family and my children, myself, we don’t access these services.

“We get in the line and we ring up for that appointment at eight in the morning. We sit in A&E for hours on end, waiting to be seen. We see the other side of it and it’s not great. I don’t think any of us would say that it’s right, but attacking the staff, blaming the staff – it’s that saying ‘don’t hate the players, hate the game’…

“People want to see GPs, but GPs are actually struggling to find work which is bonkers. Until we get back to having a solid number of GPs and some handle on the demand, we are just going to stay in this position where we’re fighting the fire and not having that family continuity of care that we all want from GPs.

“The bottom line is there’s only so many doctors, there’s only so many appointments, and there’s only so many hours in a day.”