GPs: It could take a year and a half for face-to-face appointments to get back to normal

Face-to-face GP appointments won’t get back to pre-pandemic levels for another year-and-a-half unless ministers act urgently to improve access, campaigners warned today.

Official figures show just 63 per cent of consultations were carried out in person in England in April, up just 1 percentage point in a month despite the worst of Covid being over and GPs told to get back to ‘normal’ in January.

Sajid Javid on Tuesday claimed the number of face-to-face appointments is ‘returning rapidly’ but think-tanks said general practice was recovering at a ‘snail’s pace’.

At the current rate, it would take until September 2023 for in-person GP appointments to return to the level before Covid hit, when more than 80 per cent of appointments were face-to-face. 

Fewer than half of all appointments were carried out by an actual GP, the data also shows, with the rest provided by nurses, physios and other health staff including even acupuncturists.

Emily Fielder, head of communications at the Adam Smith Institute thinktank, told MailOnline: ‘It is frustrating that, despite the Department of Health and Social Care’s pledge to return GP services to normal, NHS digital data is showing that increases in the number of face-to-face appointments are going at snail’s pace. Once again, the top-down bureaucratic structure of the NHS is failing patients.’ 

John O’Connell, chief executive of the TaxPayers’ Alliance, told MailOnline: ‘Taxpayers will be disappointed by the time GPs are taking to get back to normal. Given the huge amount they pay for the NHS, Brits expect to see their doctor face-to-face. Health bosses must ensure that all patients get the level of service they need.’ 

It comes as an internal NHS review today found the current GP system was ‘not fit for purpose’, warning the process of accessing a doctor was ‘fragmented and causing frustration’ for patients.

But GPs argue that they are being overwhelmed by surging demand at a time when family doctors are leaving the health service in droves. Twenty-six GPs retired or quit last month and around have left since the start of the pandemic.

They called on the Government to ‘outline what they are going to do protect the future of General Practice — and to protect our patients’.

Salford had the lowest proportion of patients seen in-person with less than half (46 per cent) of appointments made face-to-face. It was followed by Bury (51 per cent), Somerset (53 per cent) and Frimley (53 per cent). Some 79 per cent of appointments in Kirklees were done in person

The NHS Digital data going up to the end of April this year covers all GP appointments made in England during the month.

The proportion of consultations made in-person increased just one percentage point from the 62 per cent seen the previous month.

Increasing at that rate every month would take 17 months to reach the 80.3 per cent of appointments made face-to-face in November 2019, before Covid first struck. Pre-pandemic levels average at around 80 per cent.

A third of appointments in April were made on the phone, with 1 per cent made at home and 0.5 per cent done on video calls. 

Salford had the lowest proportion of patients seen in-person of any local authority in England, with less than half (46 per cent) of appointments made face-to-face.

It was followed by Bury (51 per cent), Somerset (53 per cent) and Frimley in Surrey (53 per cent). Some 79 per cent of appointments in Kirklees in West Yorkshire were done in person. 

The NHS data also showed just under half of all GP appointments last month were carried out by fully-qualified doctors, with patients seen by other staff including nurses at the rest of appointments

The GP Worklife survey found more than half of family doctors worked for six sessions a week or less every week in 2021, with each session being four hours and 10 minutes. Nearly a fifth of the workforce saw patients for four sessions or less, while 12.4 per cent worked for five sessions and 27.9 per cent worked for six

Despite calls to introduce more stringent policies to ensure GPs start making more in-person appointments quicker, the Health Secretary claimed ‘things are returning rapidly’.

Speaking at a conference on Tuesday, Mr Javid said people would understand it will take time for things to return to normal. But he added GPs already have the backing of Government, and people have a right to expect access to improve quickly.

Asked if people should patients should come to expect a permanently damaged GP system after the pandemic, Mr Javid said: ‘I think everyone understands why we couldn’t have a regular GP service during the height of the pandemic.

‘I think people also understand as we’re now learning to live with Covid, things are returning rapidly but its still taking time.

‘The good news is things are returning rapidly, including face-to-face appointments, which I think are vital and should be a choice for people.

‘We were right over the winter to support with record amounts of funding with what is called the Winter Access Fund and then Omicron came along which meant the recovery took longer than anticipated.’

He added: ‘Do we have to get used to some sort of permanent change of service? No, absolutely not. GP services are rapidly recovering.

‘I think GPs across the country have worked incredibly hard, they continue to do so, they need the support of Government — which they have — but people can absolutely expect to have what you would refer to as a normal service once again.’ 

The NHS data also showed just under half of all GP appointments last month were carried out by fully-qualified doctors, with patients seen by other staff including nurses at the rest of appointments.

Doctors pointed out the number of full-time equivalent GPs employed in England fell from 27,769 in March to 27,743 in April.

Overall, there are now 1,662 fewer full-time equivalent GPs since 2015. Meanwhile, the number of patients registered at practices across the country reached a record high of more than 61.6million last month.

Dr Brian McGregor of the Rebuild General Practice campaign said: ‘The NHS workforce data for England released today, continues to highlight the crisis we are facing in General Practice. The data is clear and it’s terrifying. 

‘While patient numbers go up, GP numbers continue to fall with 26 more lost in the past month alone. This is dangerous – for doctors, our staff, but most of all for our patients.

‘To put this into context, since 2015 we have lost more than 1,600 fully qualified full time GPs, despite the average number of patients each GP is responsible for increasing by around 300 in the same time frame.

‘We cannot wait any longer. The Government must outline what they are going to do protect the future of General Practice – and to protect our patients.’

It comes after a review found the current NHS system for seeking care ‘is not fit for purpose’.

The ‘stocktake’ commissioned by NHS England and led by practising GP Dr Claire Fuller said the current system is ‘fragmented and causing frustration’ for patients wanting GP appointments, and also frustrates staff.

It calls for a more streamlined system for the way people access NHS urgent care in England, bringing together online advice, community pharmacies, GP surgeries, out of hours, urgent treatment centres and NHS 111.

These ‘separate and siloed services’ should be organised into a ‘single integrated urgent care pathway’ in the community ‘that is reliable, streamlined and easier for patients to navigate’.

The graph shows the number of GP appointments per day in January. Since 2019, GPs have been asked to work evenings and weekends. But just 22,000 patients were seen on the average Saturday in January, compared to around 1.2million per week day

The report noted that some regions already have teams ‘working as a single urgent care team, including allied health professionals, community nursing teams and others to offer their patients the care appropriate to them when they call the surgery or book an online appointment’.

It added: ‘We need to enable primary care in every neighbourhood to create single urgent care teams and to offer their patients the care appropriate to them when they pop into their practice, contact the team or book an online appointment.’

Dr Fuller said people waiting for an appointment with their GP ‘prioritise different things’ and this needed to be recognised.

She added: ‘Some need to be seen straight away while others are happy to get an appointment in a week’s time.

‘Some people – often, but certainly not always, patients with more chronic long-term conditions – need or want continuity of care, while others are happy to be seen by any appropriate clinician, as long as they can be seen quickly.

‘Equally, for some patients it is important to be seen face to face while others want faster, more convenient ways of accessing treatment and there is emerging evidence of a growing appetite (even before Covid-19) for patients to access care digitally.’

The new report said bringing together a range of services would free up time for those with long-term conditions and who need care from the same professional.

‘Inadequate access to urgent care is having a direct impact on GPs’ ability to provide continuity of care to those patients who need it most,’ the report said.

‘In large part because of this, patient satisfaction with access to general practice is at an all-time low, despite record numbers of appointments: the 8am Monday scramble for appointments has now become synonymous with patient frustration.’

NHS chief executive Amanda Pritchard, who commissioned the review, will now work to implement the recommendations.

She said: ‘General practice is the bedrock of the NHS, acting as the front door to healthcare with GPs and other primary care professionals providing treatment, advice and support to more than one million patients every day.

‘I have heard how much people value access to these vital services which is why I commissioned this stocktake to ensure that as we join up services through Integrated Care Systems, we make it as convenient as possible for everyone to get the right care for their needs at the right time.’

Dr Fuller said: ‘As a GP, I know only too well the importance of supporting people – patients who come to my surgery might present with a medical condition but so often this is exacerbated by other factors; financial concerns, housing issues or poor air quality.

‘Newly formed Integrated Neighbourhood Teams, which should evolve from Primary Care Networks, are perfectly placed to bring together the right partners to tackle people’s overall health and wellbeing needs.’