How rising patient numbers threaten to overwhelm GPs

Rising numbers of patients needing care and a shortage of GPs is threatening to overwhelm the system, doctors and patient groups are warning.

It comes after the pandemic has caused severe disruption to GP practices for more than a year.

Analysis of NHS England data by the Health Foundation found more than 28 million appointments were booked in March, among the highest recorded.

Doctors' leaders say what they are being asked to achieve is "undoable".

The analysis of NHS Digital data in England carried out by the Health Foundation for the BBC also found that that between 2019-20 and 2020-21:

• The total number of appointments dropped by 10% - meaning 31 million fewer consultations with GPs and practice nurses

• Major shift from face-to-face to remote consultation, with the proportion seen in practices dropping from 79% to 54%

• The number of patients referred by GPs for urgent cancer check-ups dropped by 15%, putting lives at risk

The escalating situation has prompted patient groups to call for an urgent review of access to services, amid reports that patients are struggling to get through.

'There is an endless wave of sick patients'

Doncaster-based GP Dr Dean Eggitt has never seen anything like this: "We have almost a tsunami of patients coming to us - it feels like the river has flooded the banks.

"It just keeps coming and coming and coming in this one massive, endless wave of patients who all are ill and need help and input.

"They're sick, they're complex and we've got very few places to send them. I wouldn't want to be my patient right now."

Dr Eggitt's experience is not unique. There were 28.4 million appointments in March, once you include those made with practice nurses as well as GPs - that is one of the highest on record.

But he says he worries most about the "hidden wave of patients who don't get through".

One of those is Sharron, who ended up in hospital after she struggled on at home for weeks getting more and more sick. She was eventually diagnosed with colitis and had lost so much blood, she needed four emergency blood transfusions.

She says a combination of busy phone lines and not wanting to bother the practice meant she deteriorated at home. "When I finally got through I knew I was really poorly, I had never felt so ill in my life."

She was immediately invited in for a consultation and sent to hospital.

'We have just seen the tip of the iceberg so far'

There could be millions of people in a similar position. There were 279 million appointments made with GP practices in England from April 2020 to March 2021, compared with 310 million the year before.

The biggest drops were seen in the Midlands, North East, Yorkshire and East of England, according to the Health Foundation analysis.

The data is not collected elsewhere in the UK, but the reports surfacing suggest the problems are similar. That has, the Health Foundation warns, created a huge amount of unmet need.

This much can be seen from the drop in urgent referrals where GPs suspect someone has cancer. The numbers sent to hospital for check-ups have dropped by 15% since the pandemic started - that's potentially 367,000 people with symptoms who have not been sent for further investigations.

Sara Bainbridge, from Macmillan Cancer Support, says the disruption to services has had a "devastating impact", saying it is leading to fewer diagnoses, and reducing survival chances.

And it's not just cancer patients. Dr Becks Fisher, a GP in Oxford and senior policy fellow at the Health Foundation, says there are people with other serious conditions, such as heart failure and non-Covid respiratory problems, who have stayed away too.

"Their health will have deteriorated as they have not been getting the help they need. The people we are seeing now are coming in with really complex problems. And it is those in deprived areas who have been affected the most."

She says this is being compounded by a significant rise in people seeking help with mental health problems, as well as those "ricocheting" back from hospital because their health has worsened while waiting for treatment.

Latest figures show there are more than 400,000 people who have been waiting over a year for routine treatment, such as knee and hip replacements - up from 1,600 when the pandemic began.

"I think we are only seeing the tip of the iceberg at the moment - this is going to get a lot worse in the coming months" added Dr Fisher.

The remote consultation problem

One of the key barriers, some say, is the lack of face-to-face care that is available. Social distancing restrictions and infection control procedures mean GPs have had to rely heavily on remote consultations.

The number of face-to-face consultations has dropped significantly - down from 79% of total appointments in 2019-20 to 54% in 2020-21. And even now with restrictions easing, the numbers being brought in are still well short of what they were.

One of those who has fallen foul of this is Helen Cowley, 55, from Swindon. She had a telephone consultation for ear pain and was advised to seek private treatment for the build-up of ear wax. When she got to the clinic, they diagnosed an ear infection and she had to phone her practice back.

"It was nearly two months before I got the proper treatment - and to be fair I thought it was ear wax too. It was obviously not the most serious problem in the world, but not being able to be seen face-to-face is not ideal. You can see how things can be missed and for some patients that may have huge consequences."

Patient watchdog Healthwatch England is particularly concerned about the lack of face-to-face appointments, and is calling for an urgent review into the situation.

National Director Imelda Redmond said while remote consultations suit some patients, there are many who have struggled with the arrangements that have been put in place.

"Those affected are often the most vulnerable in our society - older people, disabled people, those affected by homelessness and on low incomes."

A problem that has been brewing for years

The issue has already prompted action at the highest level. NHS England wrote to GPs in mid-May saying patients must be offered face-to-face appointments if that is their preference, unless there was good reason not to, such as the patient displaying Covid symptoms. Extra funding has been provided too.

But the move has been met with some opposition from GP leaders who have raised concerns about the lack of space in GP practice buildings, with the British Medical Association's GPs committee even passing a motion of no confidence in NHS England.

BMA GP leader Dr Richard Vautrey says doctors were left "angry, frustrated and disappointed" by the letter, especially given the "incredible contribution" GPs have made to the vaccination programme - around three-quarters of jabs have been given in GP-led settings.

In many ways, this is a problem that has been building for a while. There has been a big push in recent years by the government to increase the number of GPs to keep up with rising demand, but once you exclude locums and trainees the number of permanent GPs has actually fallen by nearly 2,000 in the past few years to just under 27,000 full-time GPs.

Prof Martin Marshall, chairman of the Royal College of GPs, says it means what is being asked of the profession now is simply "undoable".

"General practice was already facing intense workforce and workload pressures - the pandemic has only exacerbated these. We urgently need more GPs and other members of the practice team."

Additional reporting by Ruth Clegg

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