GP appointments are hard to get, say third of NHS patients in England

Difficulty seeing same doctor, booking online or obtaining evening appointments casts doubt on David Cameron’s aim of 8am-8pm, seven-day GP access

A third of patients find it difficult get a GP appointment, see the same doctor on each visit to a surgery or book a consultation online, according to research by the financial regulator for the NHS in England.

One in 10 people say they are more broadly dissatisfied with their GP surgery, citing the inconvenience of accessing services the main frustration.

A representative survey of 3,315 patients in England on behalf of Monitor found that very high proportions of patients believe that their GP practice is meeting their expectations. More than 90% said their surgery was easy to get to and close to a pharmacy, had both male and female GPs and enjoyed a good reputation.

But 30% said it was not easy to get an appointment. Ease of getting appointments was the second-most important feature after closeness to home that people wanted when looking to find a GP practice.

A larger number of those surveyed (35%) said they could not get to see the same doctor every time they went, while 34% are registered at a surgery that does not offer online appointment bookings.

And almost half (46%) said they could not see a GP at their practice in the evenings or at weekends, underlining how difficult David Cameron will find it to deliver his pledge of every patient being able to see a GP from 8am to 8pm every day of the week, which is a key element of his promise to make the NHS the world’s first truly 24/7 healthcare system.

The survey also found that more than one in five (22%) are unable to request a telephone consultation with a GP, despite strong indications that this helps to reduce the pressure on overstretched surgeries.

GP leaders said the findings were further evidence of growing patient concern over the difficulty many face getting an appointment, but said the growing shortage of family doctors made easy access impossible.

“We share Monitor’s concerns that our patients are becoming increasingly dissatisfied with the ease at which they can make a GP appointment”, said Prof Maureen Baker, the chair of the Royal College of GPs.

“Family doctors and our teams across the country are working harder than ever to meet the demands of a growing and ageing population, but there are simply not enough GPs to offer any more appointments. We are making 370m patient consultations a year – 70m more than five years ago – yet our workforce has remained relatively stagnant and the resources that our service receives has dropped to an all-time low of just over 8% of the overall NHS budget”, Baker added.

Simon Stevens, chief executive of NHS England, admitted on Sunday that the government had underfunded GP services in recent years.

Dr Chaand Nagpaul, chair of the British Medical Association’s GPs committee, said many surgeries lacked resources, staff, infrastructure and in particular GPs themselves. “Many GP practices are struggling to treat the sheer number of patients coming through their doors and deliver enough appointments,” he said. A rising number of older patients, who often required longer, more complex consultations, added to the problem.

Nagpaul highlighted Monitor’s finding, based on fieldwork by Ipsos Mori as part of its review of GP services, that “a substantial majority of patients are satisfied with their GP practice and the large majority of GP practices perform well against NHS England’s and the Care Quality Commission’s quality indicators”.

Ministers should concentrate on expanding GP numbers rather than “promising patients undeliverable services” so that “practices can actually deliver basic care to their local patient populations,” he said.

Anna Bradley, chair of the patient watchdog Healthwatch England, said: “It’s great to hear that so many people are generally happy with the standard of their GP surgery. However, it is still disappointing that at least a third of people are struggling to access appointments.”

Healthwatch has previously found that a lack of evening appointments and difficulty booking telephone consultations “often act as barriers to patients booking a GP appointment when they would like, with a doctor of their choice. We know that as well as being frustrating for patients, this also often means that people think their only other option is to visit A&E, which puts additional pressure on other parts of the system”, she added.

Monitor found that 17% of patients who cannot get a timely GP appointment would go to A&E, 16% would book to see to see a family doctor at a different time, 12% would call NHS111 and 6% would call an out-of-hours GP service.

Catherine Davies, Monitor’s executive director of co-operation and competition,said patients could force GP surgeries to improve by switching to those whose services better suited their needs.

A separate study has found that more than 160,000 patients have been forced to find a new GP surgery over the past two years after their own practice closed.

The figures, obtained by the medical magazine Pulse from the NHS under freedom of information laws, show that 61 surgeries across the UK have shut since 2013

In London, for example, 22 practices have closed in that time, displacing 52,000 patients, who then had to find another surgery that would let them register.

Dr Tony Grewal, medical secretary of Londonwide local medical committees (LMC), which represents GPs in the capital, said practices closing led to neighbouring surgeries coming under even greater pressure, but that practices felt obliged to take new patients because people cannot be left without a family doctor.

Nagpaul said the 61 closures were “the tip of a much bigger iceberg. There are many practices on the brink of collapse, while others are significantly reducing the level of services they can offer”.

Seven surgeries have closed in the Midlands since 2013, affecting 27,000 patients. Dr Robert Morley, executive secretary of Birmingham LMC, said the situation was “absolutely dire and getting rapidly worse. We have small partnerships that are becoming unviable because of issues of recruitment, retention, impossible workload, GP illness and singlehanders retiring, and practices are also being closed by the CQC”.


Denis Campbell Health correspondent

The GuardianTramp

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