A growth in the average life expectancy, a reduction in the number of new GPs entering the profession, an increase in the number of practitioners taking early retirement, changing their medical discipline or emigrating, coupled with a dramatic reduction in funding over recent years have, individually and in combination, created a vicious circle, one of the consequences of which is a significant increase in the length of time that patients have to wait for an appointment with their GP.
More than 50% of the country’s population told a poll commissioned by the Royal College of General Practitioners (RCGP) and published on 26 September 2014, that they believe GP appointment waiting times to represent a “national crisis”, with less than a quarter believing that there is a sufficiently large pool of GPs to cope with the health demands of an increasingly aging population. Two thirds of those who participated in the poll also expressed their concern that GP workloads are so large that they threaten the quality of care that GPs are able to give to their patients.
Increased Waiting Times: The Causes
The situation has reached this calamitous state, the RCGP believes, because of an amalgam of factors.
- A chronic shortage of general practitioners. The college estimates, in fact, that England requires another eight thousand full-time GPs to meet the increasing demands on them. In the face of this need, however, the pool of GPs looks likely to fall rather than rise in the foreseeable future, largely as a result of the combination of these spiralling workloads and the increasing numbers of GPs leaving practice for the reasons referred to above. The RCGP believes that, by 2022 there will be one thousand practitioners leaving the profession every year yet there are now almost four times as many unfilled GP posts as there were in 2011.
- In the face of the increasing workloads and a depleting workforce, funding for GPs has fallen to an all time low as a percentage of the overall NHS budget, thereby both exacerbating and perpetuating the problem.
This circular dilemma does not show any sign of abating, especially in the light of the call for patients to reduce waiting times in Accident and Emergency admissions by making an appointment with their GP rather than attending hospital and the College’s prediction was that patients would have to wait for a week or more to see their GP or practice nurse during the course of 2014. Even more worrying was their suggestion that some patients would fail to see a GP at all.
GP Response to the Problem
GPs have worked hard to meet these challenges and initiate improvements in their practices. These initiatives have involved establishing new procedures, policies, systems and philosophies, with the aim of streamlining their practices for improved efficiencies and offering a more attractive, commercial option for potential recruits. These proactive measures have gone a long way towards accounting for an increase in annual patient treatments of forty million over the last five years, with each GP also conducting an additional one thousand five hundred consultations per year compared to 2008 but GPs cannot be expected to address the issue of increasing waiting times single-handedly and simply putting in more and more hours is more likely to perpetuate the problem than to resolve it.
Addressing the Issue
Despite the introduction of improved practice efficiencies on the part of GPs, the RCGP is firmly of the view that the situation will only be resolved through positive measures which must include a governmental commitment to training eight thousand additional GPs, the provision of increased incentives for trainee GPs and those working in deprived areas where there is a shortage of practitioners and an increase in the share of NHS funding for GPs from its present level of 8.39% to 11% by 2017.
The issue of the lack of new entrants into the profession is where the RCGP diverges most markedly from present governmental policy, which is geared more towards external sourcing, including from overseas, rather than directed to increasing the number of domestic trainees by creating a more attractive professional infrastructure and a career path where the rewards achievable are commensurate with expertise, experience and endeavour and are not overshadowed by the physical and psychological demands that presently deter so many potential GPs from committing themselves to a career in general practice.
In addition to the proposals of the RCGP, we would suggest that certain additional steps might be taken to address the issue of delay by better use of practice resources. These include the following key measures:
- Making proper use of the skills of practice nurses by making them the initial point of contact for patients suffering from chronic conditions and minor illnesses. If the practice nurse considers a GP referral is necessary, that referral can be made, providing a seamless transition to GP care. This measure would inevitably increase the time available to GPs to spend on the more complex patients in the practice’s caseload and reduce their overall individual workloads. The resultant effect on reducing waiting times for all of the practice’s patients is obvious.
- The assimilation into GP practices of other health professionals, such as paramedics and pharmacists, who, together with the practice nurses, would form a team of experts to work under the aegis of the GP, who would ensure that individual patient care is targeted to the appropriate team member to optimise operational efficiency.
- Embracing and exploiting the opportunities created by technological advances that offer the facility to conduct remote consultations by telephone or video conference, which would not only reduce the need for personal appointments but would also enable a collaborative approach with other practices, where patient consultations could be allocated effectively between their respective professionals during periods of the greatest demand.
Clearly, the issue of increasing GP waiting times is attributable to a combination of external and internal factors. For that reason, we would suggest that the only effective way of combating the problem is through the type of multi-faceted response set out above. In other words, the only viable way of treating the effect is by directly addressing the root causes.