Appointments – Fixing the Unfixable

Appointments – the perennial problem!

Getting an appointment at your GP surgery is difficult. It has always been difficult. This is not new. It has been this way for as long as I can remember.

General practice works at 100% capacity every day. This means that within just a couple of hours each day, all our routine appointments are taken. We are not unique – this is replicated up and down the country. 

So why is this?

In this post I would like to try and explain why this is the case, and what we are trying to do to help “fix the unfixable”.

What about getting more doctors?

Buildings

We have steadily expanded. Our surgery was originally built to serve 3000 patients. In 2001 when I joined the practice there was a clinical team of 6, sharing 5 rooms. Our same building now serves 7500 patients. There is now a clinical team of 14 sharing 8 rooms.

This has been achieved by internal revisions in 2008, and then an extension in 2018. However, within weeks we reached maximum capacity for the building again. We have no more spare room.

Staffing

Whilst the population has risen, the number of GPs has continued to fall. Since 2015, when ministers first began making promises about increasing GP numbers, England has lost the equivalent of more than 1,700 full-time, fully-qualified GPs. For those left, the average number of patients each GP is responsible for has increased by around 300 – or 15% – over the same period. (BMA).

Even within the Hythe & Waterside locality, there have been long-term unfilled vacancies in the last year. 

Fewer GPs & more patients means we are spread more thinly, and find ourselves looking after more patients in the same amount of time each day.

Why are we so busy?

Complexity of Care

Over the years, as hospitals have become busier, more complex care has been moved into the community meaning GPs and nurses are dealing with more patients who need multiple appointments, all of which places extra strain on the system. Together with an aging population, this places a higher demand on our services.

The COVID Legacy

For the last two years General Practice has had the added burden of the consequences of a global pandemic.

• As hospital waiting lists rise to all-time highs, we are looking after sicker and frailer patients whilst they wait for their hospital care or operations.
• We have had to provide the biggest vaccination drive in the history of the NHS alongside our normal work provision. Now it looks like we will be doing this for the rest of 2022 following recent announcements about further spring and autumn boosters for the over 75s and certain vulnerable groups.
• Our efficiency has been compromised by the Standard Operating Procedure set out by NHS England which means we have to remotely triage our patients before seeing them (the reason you must have a phone call first). In addition, the infection control rules we must follow mean we have to carefully manage the number and types of patients in our waiting room each day. These requirements are still in place, and we have no idea when they will end.

Having to deliver different types of care

One of the most controversial additions to our services in recent years has been the requirement to provide electronic consultations, initially 24/7. These have been a double-edged sword. They work extremely well for patients who want simple written advice, or administrative help, and it cuts out the need to wait on the telephone. However, they are often poorly completed and lack important information. Doctors must be taken away from telephone or face-to-face consultations to triage these EConsults safely, further depleting the available appointments.

Because there is no limitation on the number of EConsults we receive in any given day, we have recently had to take the decision to limit the times these can be submitted to the opening hours of the Surgery. 

Increased demand and expectation

Over the years medicine has delivered more treatment options for patients. We have more complex services to offer, medications to monitor, and more complex conditions we now manage in primary care. Press coverage, the internet and social networking all drive demand upwards, sometimes when there is not always a need. 

In addition, we now live in a much more immediate culture, (the “Amazon Prime” culture), where requests can be made 24/7 and there is an expectation of delivery of a service the following day.

The NHS is simply not able to fulfil these kinds of expectations. Whilst the country and politicians decide the thorny issue of the difference between what they want, and what they can afford, we in front line general practice are struggling with the problems here and now.

(Did you know that over 90% of all NHS patient contacts each day occur in General Practice, and all for less than 10% of the NHS budget. BMJ).

Why is it sometimes difficult to get through on the phone? 

We are back to the building and space again. All our space is currently occupied, and we have no more room to fit anyone extra in. Our admin team is the biggest it has ever been, but we cannot match demand. Their roles are complex and multiple and go far beyond the role of just answering the phone to book appointments. 

Our highly trained staff have seen unprecedented levels of abuse and rudeness in recent years and turnover of staff has consequently risen. Again, this is happening across the country (see here). Unfortunately training new staff takes time and slows down the efficiency of the system. 

What are our future threats?

The Waterside population is set to rise with the arrival of the housing developments in Fawley & Marchwood. We have been told in no uncertain terms that there will be no new GP surgery to take on these patients, and the existing practices will have to absorb the new population. 

The burden on our Waterside Primary Care Network (the three practices of Waterfront & Solent, Red & Green Practice and Forestside Medical Practice) is going to get tougher and we have been looking at solutions together.

What are we doing to try and fix the unfixable?

In 2018 we built an extension on our Surgery to provide us with two new consulting rooms. This has meant that we have been able to expand our workforce to offer more appointments.

In the last few months, we have been redesigning the interior of the Surgery. Old paper medical records have now been moved off site, and soon we will have a larger redesigned space for our administration team, and we hope this will be future-proof. We should also be able to accommodate more primary care network staff to support us.

Later this year, with the opening of the new Hythe Hospital, the Practices of the Waterside PCN plan to relocate their Urgent Care Services (same day appointments) under a single roof and provide a coordinated, at scale service, for all three practices. We hope that this will release both space, GPs, and appointments for more routine care in each of our practices.

In Summary

We are always trying to improve our services and provide the very best for our patients. We understand your frustrations about appointments and are doing our very best to minimise this wherever we can.

To stay up to date with our latest news about the progress of the development of the urgent care hub and other news, please click here.