Face-to-face GP appointments on demand 'unachievable', warns RCGP chair

Calls for general practice to offer face-to-face appointments to all patients who want them are 'unachievable' given GP shortages and rising demand, the RCGP chair has warned.

RCGP chair Professor Martin Marshall (Photo: Pete Hill)

Asked whether NHS patients have a 'right' to see their GP in person, college chair Professor Martin Marshall told MPs he had heard calls for this to be the case.

But he told the House of Commons health select committee: 'There is no point in saying you have a right if it is undeliverable - and it is essentially undeliverable at the moment because of the workload pressures.'

Professor Marshall's comments came just a week after health and social care secretary Sajid Javid said in parliament that it was 'high time' GPs offered face-to-face appointments to all patients who want them, now that life in the UK was 'almost back to completely normal'.

Face-to-face appointments

The RCGP chair told the committee that GPs try to meet patients' preference, and that shared decision-making between GPs and patients on whether a face-to-face appointment was necessary was the best approach.

However, he told MPs: 'There are people who like and get real benefit from remote care; there's people who need face-to-face care; and there is a large group who would like face-to-face care but general practice doesn’t currently have the capacity to deliver it - and that is the bit that is the real problem for patients and general practice.'

An 'absence of workforce planning' has been a significant problem for the NHS since its inception in 1948, Professor Marshall argued, and is 'getting worse'. He pointed out that promises to increase the GP workforce had failed to materialise, with 2.5% fewer full-time equivalent GPs now than in 2019, and 4.5% fewer than in 2015.

And despite record recruitment and numbers of GPs in training, he warned that the 'plug is out of the bath' - with rising numbers of GPs retiring early because of intolerable pressure, or reducing their working hours.

GP workforce

'Need is going up, but the supply is not,' Professor Marshall told the committee. He said general practice was facing intense pressure from managing increased workload linked to the backlog of hospital care triggered by the pandemic, rising demand for consultations in primary care, increased complexity of care required in general practice and a rising workload from the COVID-19 vaccination campaign and expanded flu jab programme, and an expansion of services over time in primary care.

Professor Marshall told MPs that 'somewhere from 5-10% more patients are being seen' in general practice now compared with an equivalent period before the COVID-19 pandemic.

He added: 'In addition to that we are seeing much more complex problems in the consultations - the average consultation is 9.8 minutes, the average number of problems dealt with is now nearly three - so three minutes per complex problem we are dealing with in general practice - it is very difficult to deliver that.'

Face-to-face appointments remain fundamental for general practice, particularly for complex cases, Professor Marshall told the committee. However, he said the profession had come to understand from the experience of the pandemic that 'we can do more remotely than we thought'.

Remote care

He said practices that had been early adopters of remote consultations had found that it took two to three years for patients and clinicians to adjust - and that a similar process would have to happen nationally.

The right balance between face-to-face and remote care varied from practice to practice depending on the population, Professor Marshall told MPs. But he argued that nationally, the current ratio was 'about right' - with around 56% of appointments in person, compared with around 80% pre-pandemic.

Professor Marshall also warned MPs that for healthcare services, the pandemic was 'far from over' - even if rules had changed for 'pubs and clubs' - and that practices continued to follow NHS advice to maintain good infection control.

He also called for a drive to reduce unnecssary bureaucracy in general practice to adjust the balance between the amount of time GPs spend on direct patient care and administrative work.

Citing bureaucracy in 'ticking the boxes' for QOF, medical forms that could be completed by other clinicians, the potential for an expansion of non-medical prescribing and CQC checks, he called on MPs to reduce the administrative burden on GPs.

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