I have wanted to write a post about “demand” for a while – it’s not a word I like, patients are generally not demanding of us…but I can’t think of a better term. The number of patients requesting clinical care is rising month on month and we do not have the capacity to see everyone as quickly as they would like. There is a mismatch. My job is busier than I have ever known it. What I want patients to understand after reading this post is that we are doing our best and it is reasonable to have to wait for routine care. I think it is important that we are honest about what to expect from general practice in the current climate.
At the moment it feels impossible to fit everything in, patient care and staff wellbeing are the priorities, but something must give for us to continue to offer our services safely, and for now that is “routine care”.
Why are we seeing higher “demand” for our service?
- NHS backlog – during the peaks of Covid-19 cases some routine procedures/tests/clinics were paused, and this has created a delay for some hospital services. We feel the effect of this e.g. a patient is awaiting a knee replacement, it has been postponed several times, their pain increases, they are unable to walk as far, maybe they put on weight, their mood dips and who is there to support them while awaiting this surgery? We are.
- Some patients avoided coming to see us during the peak months of the pandemic, this may have been due to fear of catching Covid-19 or heeding the advice to protect the NHS and stay home. Some patients feel more comfortable or confident now lockdown has eased and vaccination rates are higher. The phone lines are easily saturated and often a patient will give up trying to contact us due to a long wait on hold. A delay in coming to see us with new symptoms could lead to more serious or complex disease.
- An increase in patients presenting with mental illness. Symptoms of depression or anxiety are common, but the pandemic has heightened our fear, encouraged isolation,and reduced our access to normal support networks or activities.
- Covid-19 itself. Queries about shielding, the vaccination programme, symptoms of the virus all add to the workload.
- Staffing problems: as cases rise locally, staff are affected by burst childcare bubbles or self-isolation awaiting a PCR swab result for themselves or a family member. While we try to manage this by having some staff work remotely at home, this is not always feasible and will have an impact on the number of appointments we can offer.
The simple answer to the problem of increasing demand must be to provide more clinicians? Unfortunately, it is not that easy. It takes years to train specialised staff and numbers have been falling due to several factors: workload, Brexit, retirement, change in training, pension changes…How about we open longer? Again, this isn’t simple – we would need to move the same number of staff and spread them thinner across a longer day or over weekends. Asking our staff to work extra hours when they are already working their socks off just isn’t fair. A lot of NHS staff have worked on their days off to help support the vaccination programme and burnout is a real threat. We need to protect and support our staff, not encourage them to work harder and longer.
For my practice specifically, we aim to deal with urgent queries within 1 working day (i.e if you contact us at 9.15am you might be called at 11.25am or 5.59pm that day). It is very difficult to work to a specific timeframe for a clinician to contact you as we are constantly prioritising higher risk cases, and it is useful to contact patients who may need a face to face (f2f) consultation earlier in the session to give them time to get to the surgery. We use an online system to triage patient queries as urgent or routine, on average 70% are deemed urgent, so 70% of our daily patient queries are addressed within 1 working day. That is impressive.
Routine queries are generally booked about a week following your initial contact, this can be extended to up to two weeks due to staff absence or bank holidays. I don’t think it is unreasonable to wait 1-2 weeks to discuss blood results, a skin problem you have had for months or a chronic wrist problem. Much of the clinical care we provide through general practice is relating to chronic (long term) illness which doesn’t need a same day clinical response. I often find when doing a routine care clinic that a patient’s symptoms have already resolved – minor illness often gets better without the need for treatment. Do consider using your pharmacy first, they are a great resource, or cancelling your appointment if you no longer need it.
The term “urgent” is an odd one. What a patient deems urgent is entirely different to what I consider urgent. For me, urgency related to how unwell a patient is and how quickly they are at risk of deteriorating. A patient may deem a prescription request urgent because they forgot to request their repeat medication last week and are now running out, or they may be going on holiday and want to request a tablet to delay their period. Hay fever isn’t an urgent clinical problem, but for some people it is so debilitating that they want it managing ASAP. It is all about perspective isn’t it.
I might be a GP, but I am also a patient. I find it hard at times to navigate the system so I can only imagine how daunting it might be for patients that have no experience of accessing care in the NHS. Me and my family have needed the advice and care of the NHS a few times over the last 16 months, so I understand the frustration of having to wait to speak to a clinician, but I also understand why there might be a wait.
So how can patients help us?
- If you have mild symptoms e.g. constipation or a reaction to an insect bite consider using the NHS website or your local community pharmacy for advice first of all
- Be patient with your practice, you may have to wait a few days or even a couple of weeks for a routine appointment if your problem is not clinically urgent. If you find your symptoms are getting worse, contact them again or use NHS111 if needed
- Continuity and follow up is important to us and beneficial for patients, but sometimes you will need to wait for your preferred clinician to have availability; they may be on call, have on the day urgent clinics or be on annual leave
- If you have been asked to get in touch about some results, try not to worry about this. If there was an urgency to any abnormal results the clinician processing them would have highlighted this. It is OK to wait a week or two to discuss mildly abnormal test results
- Read your practice website for details on how to access appointments, use an online option if this is available and you feel comfortable using it, this can leave the phone lines free for those who do not have online access
- If a member of staff at your practice has done a great job, let them know at the appointment or even send an email or letter of thanks. It can be hugely uplifting to know you are making a difference even when the job is busy or challenging
We are doing our best, but it is challenging. The job of a GP is way more than the visual part of speaking to and seeing patients. We do a lot of admin throughout the day, support allied health professionals and trainees, respond to complaints, liaise with hospital colleagues and it is difficult to fit it all in. It may not look like the waiting rooms are bursting full of people but those working in general practice are working extremely hard. Please be patient with us so that we can put all our energy in to patient care.