GP practices 'at breaking point' after 20% surge in appointments last month

GP practices in England are working harder than ever before, the BMA has warned, as official figures showed the profession delivered 4.8m more appointments in March compared with the previous month.

GP practices under pressure (Photo: Robert Johns/UNP)

Figures on GP appointments from NHS Digital show that GP practices in England delivered 28,570,000 appointments in March this year, compared with 23,720,000 in February - a 20% rise.

The March total is the highest figure recorded since October 2019 - and is likely to significantly underestimate workload because multiple telephone appointments can appear as a single event in the data. The data also largely exclude work carried out under the COVID-19 vaccination programme, which has seen GP-led teams deliver the vast majority of more than 47m doses UK-wide.

The figures come after GPonline reported last month that GP practices had delivered hundreds of thousands more appointments in the early weeks of 2021 compared with the same period in 2020 - while the burden of clinical administrative tasks has risen by a third.

GPs under pressure

BMA GP committee chair Dr Richard Vautrey said general practice was under intense pressure, with soaring demand leaving an understaffed profession working long hours and stretched to breaking point. He said the appointments data provided 'categorical proof' that claims GP practices had not remained open through the pandemic were false.

The Leeds GP said: 'Today’s figures underline the immense efforts that practices are going to providing care to their communities and the intense workload pressures that staff are under as we continue to respond to the pandemic alongside patients’ wider health needs.

'Practices in England delivered almost 5m more appointments in March than they did the month before, and nearly 3m more than they did in the same month two years ago, long before the onset of the pandemic.

'GPs and their teams are consistently telling us they’re busier now than they have ever been, and this data - which does not include a large proportion of the vaccine programme undertaken by practices, nor a vast amount of other daily tasks - backs this up.'

COVID-19 vaccination

NHS England has yet to reveal the number of practices that have opted in to deliver COVID-19 vaccinations in the second phase of the campaign, covering cohorts 10-12 identified by the Joint Committee on Vaccination and Immunisation - but GPonline has reported that workload is a key factor that has driven many practices to opt out.

Earlier this month the Doctors Association UK wrote to the government demanding an urgent review into unprecedented GP workload - asking for an investigation into claims that patients were struggling to access general practice at a time when the profession is reported to be seeing 10% of the population each week.

Dr Vautrey said: 'Every day, more than 1m patients in England had an appointment with their practices, whether this was the significant proportion seen face-to-face, on the phone, or, for a smaller number, via video call. This phenomenal amount and associated workload is before we consider the hundreds of thousands of other people being vaccinated via GP-led sites each day.

'With too few GPs and practice nurses - and a promise in 2015 of 5,000 extra family doctors within five years actually delivering a loss of almost 1,500 - individual doctors and other practice clinicians are taking on more and more as demand rises and the workforce diminishes.

GP burnout

'So for GPs working 11- or 12-hour days, often leading heroic efforts to protect as many people as possible in their communities against a disease that has had such a devastating impact on all of us, it is heart-breaking and completely demoralising to hear accusations that general practice is not open and that patients are not being seen.

'This narrative, categorically proven wrong by today’s data, is extremely damaging at a time when morale is already reaching rock bottom and many GPs, practice managers and others in the practice workforce are reaching breaking point.'

RCGP chair Professor Martin Marshall said: 'GPs and their teams are reporting working harder than ever at the moment, and these figures from NHS Digital back this up. The figures show the massive pressure under which general practice is working and points to the challenges that GPs face every day to provide the care that patients want and need.

'GPs and their teams are at the forefront of helping communities recover from the pandemic, caring for patients whose physical or mental health has been directly or indirectly affected by COVID-19; they are leading the COVID-19 vaccination programme with 75% of vaccines delivered in primary care; they are supporting the backlog of patients on waiting lists for services elsewhere in the NHS; and they are delivering the care and services our patients rely on - as they have throughout the pandemic.'

He said the official figures did not reflect the rise in complexity of work in general practice during the pandemic or the surge in clinical administrative work reflected in RCGP data.

'We urgently need more GPs and other members of the practice team to manage increasing workload in general practice,' said Professor Marshall. 'Good progress has been made to encourage medical students to choose general practice, but we also need to see comprehensive plans to keep existing and experienced GPs in the workforce, protecting them from burning out by addressing "undoable" workload.'

A DHSC spokesperson said: 'We recognise the enormous pressure this pandemic has put on all health and social care staff and we are investing £15m into dedicated staff mental health support. We are committed to supporting our incredible health and care staff who have kept vital services open for thousands of patients. This government continues to back the NHS at every turn.'

An NHS England spokesperson said: 'GP teams, like all NHS staff, have faced significant challenges with COVID-19 while also rolling out the biggest vaccination programme in NHS history.

'We have provided a number of financial and practical measures to support practices and their staff which include coaching and mentoring, support to recruit to wider roles across primary care, financial support for clinical directors and £270m to expand general practice capacity during the pandemic.'

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