NHS chiefs warned not to underestimate pressure on GPs as figures show sharp rise in workload

GP workload has surged sharply in recent months, official data show, underscoring reports that practice workload is already above pre-pandemic levels with the pressure of a massively expanded flu campaign to come.

GP workload rising (Photo: sturti/Getty Images)
GP workload rising (Photo: sturti/Getty Images)

Frontline GPs have been warning for some time that workload has already outstripped pre-pandemic levels - weeks before the profession begins to deliver the largest flu vaccination campaign in NHS history.

Analysis by GPonline of NHS Digital figures on GP appointments and RCGP surveillance data shows that workload has surged in recent months - and GP leaders have urged NHS chiefs not to underestimate pressure on the profession.

In June 2020, practices delivered around 28% more appointments than in April, NHS Digital figures show. A comparison of RCGP data on GP consultation workload in weeks 28-31 of 2020 and weeks 13-16, when lockdown began, shows a similar rise.

GP workload

The warning from GP leaders comes after NHS England this month urged practices to 'restore activity to usual levels where clinically appropriate', demanding practices proactively reach out to at-risk patients whose care has been delayed, calling for 'rapid progress' on tackling a backlog of child immunisations and cervical screening and more work to support care homes.

Practices will also be expected to deliver a hugely expanded flu campaign this year, with more than half the UK population set to be offered the vaccination - and with social distancing and PPE requirements set to increase significantly the time required per jab.

Pressure on GPs has also been compounded by at-risk doctors being forced to step back from face-to-face care during the pandemic, amid an ongoing slump in the general practice workforce - and with warnings that primary care networks are also struggling to recruit.

RCGP chair Professor Martin Marshall said: 'Data from the RCGP’s Research and Surveillance Centre shows that demand for routine appointments in general practice is returning to normal levels. In fact, data from during the pandemic that suggests GPs have been spending longer with patients during appointments, could indicate clinical GP workload may actually be greater than it was pre-COVID – and almost half of GPs who responded to a recent college survey indicated the same

'It’s encouraging that efforts are now being made to start resuming normal services - but the pressures GPs and our teams face over the next few months, as we deal with the aftermath of the pandemic, facilitate the expanded flu vaccination programme, and prepare for a potential second wave of COVID, must not be underestimated.'

COVID-19 pandemic

BMA GP committee chair Dr Richard Vautrey said GPs and practice teams had been working 'incredibly hard' during the pandemic to maintain access to services.

He told GPonline: 'Workload in general practice changed during the early phase of the COVID-19 pandemic but did not reduce significantly.

'We are beyond the first wave of the pandemic and many practices are telling us their workload is now greater than it was before COVID-19, and we are about to enter the largest flu season ever.'

The Leeds GP warned that it was 'critical that practices are given proper support and resources from NHS England and the DHSC'.

GP consultations

Figures from NHS Digital show that GP practices delivered 21.3m appointments in June 2020 - 28% more than the 16.6m recorded in April.

Although the June 2020 figure remains below the 23.8m figure for June 2019, NHS Digital has said that 'this decline does not necessarily imply that GPs are having fewer interactions with patients'.

The huge shift towards more consultations being carried out by telephone - consultations that the RCGP says require at least as much work as a face-to-face visit - has significantly affected how consultations are counted.

RCGP figures suggest that around two thirds of GP appointments are being delivered by phone - but NHS Digital says recording of these patient contacts is skewed by 'the use of list appointments, in which several patients are contacted but only one notional appointment slot appears in the collected data'.

It is not clear to what extent RCGP figures may be affected by this recording issue, but figures from its surveillance centre show that GP consultation workload is now higher than at any point since the start of lockdown - and overall GP consultation activity for week 31 of 2020 is only 4% down on week 31 of 2019.

Primary care data

Dr Vautrey added: 'The figures show that the methods used to record workload and appointment data may not be appropriate for the way practices are operating.

'For instance, all appointments are recorded the same, irrespective of the differences in the amount of time or work required, and this is an area we have been working with NHS England to improve.

'And so, while it is important that the data is able to reflect the true situation on the ground it is even more critical that practices are given proper support and resources from NHSEI and DHSC.'

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