Pressures in general practice

NHS Kent and Medway is working with general practice, the local medical committee and wider NHS partners to address pressures in General Practice. Like elsewhere in the country, General Practice in Kent and Medway is under intense pressure at the moment. The pandemic, coupled with the pressures usually experienced in winter months, mean that these challenges will remain with us for some time.  

Why are GP practices so busy?

There are lots of reasons why practices across the country are seeing huge increases in demand. Some of these are to do with Covid-19, such as:

  • backlog of work built up during lockdowns
  • delivering the majority of Covid-19 vaccinations and boosters in the largest vaccination programme in history
  • increased seasonal viruses following lockdowns
  • third wave of Covid-19, despite the effectiveness of the vaccinations limiting the most serious effects of the virus.
  • increased waiting lists for surgery meaning some people are living with untreated conditions and need ongoing and increasingly complex support from the General Practice team.

There are also pressures that existed before the pandemic, for example: 

  • GP workload has grown in volume, complexity and intensity
  • recruiting into General practice teams
  • infrastructure and premises (such as buildings and telephone systems)

GP practices have been open thoughout the pandemic and, although the way they worked had to change to protect their patients, they never stopped seeing people. 

You can find the latest appointment data here. 

Why is it more difficult to see a member of the general practice team face-to-face?

Face-to-face appointments  have been back at pre-pandemic levels consistently since around June 2021 with some short-term exceptions (for example while practices prioritised the booster campaign at Christmas, delivering 300,000 vaccinations in a month).

Between April 2019 and February 2020 (10 months prior to the pandemic), general practice in Kent and Medway carried out 7.5million appointments.

Between April 2021 and February 2022 (10 months ‘post’-pandemic), Kent and Medway practices delivered over 9million total appointments.

General practice carried out over 1.5million more appointments in the same time period.

The number of face-to-face appointments has remained around the same at just over 5million a year. This means that while a lower percentage of total appointments are taking place face-to-face, the same number of face to face appointments are being carried out. Were these to increase the number of appointments offered would need to be reduced.

How are practices working?

Most practices had started to introduce telephone triage before the pandemic and, although circumstances sped up adoption in some areas, this is now how most practices will work in the future.

Appointment requests and other queries are triaged by a trained call handler to identify the right member of staff to see the patient through the right type of appointment.

Many practices use econsult, an online triage system for those people who have digital access to be able to request an appointment without needing to call the practice. 

The multi-professional team

The workforce in General Practice has been changing for some time with a range of trained clinicians now working in practices, making sure patients can see the right person, first time. These include paramedics, nurse practitioners and social prescribers. More information on these roles can be found here

When you call your practice you will be asked questions to determine who is best for you to see, which may not always be a GP.

 

Other actions include: 

• hospital waiting list queries – people on hospital waiting lists have traditionally had to contact their general practice for updates, which needs the practice to follow up with the hospital. We are working with all hospitals to implement direct enquiries services to make it easier for patients.

• medication on discharge – people leaving hospital often need continuing medication, but were routinely prescribed just two to three days of supply by the hospital, meaning people have to quickly contact their practice to arrange further supplies. We have increased the amount of medication prescribed on discharge for a temporary period to avoid people having to go back to their GP so quickly.

• internal hospital referrals – if one hospital service sees a patient and identifies a need for an appointment with another service, the patient is normally directed back to general practice to make a new referral. We are investigating how an internal referral can be made directly from one hospital service to another.

• promoting alternative services – 111, pharmacies and urgent treatment centres can provide the advice and care that some patients need. We continue to work with practices and the public to promote suitable alternatives to contacting general practice. Visit our Stop, think, choose webpages for more information.  

• phone system capabilities – some practices have inadequate phone systems for the level of demand now being experienced. We have used some of the funding given to us  to improve phone systems for all those practices in Kent and Medway who were not on a cloud-based system. 

• remote monitoring solutions – during the pandemic, we developed a successful remote monitoring service for blood oxygen levels. A similar model is now being developed for blood pressure monitoring.

• increased capacity for blood testing – routine blood tests are a significant activity across general practice. We have increased capacity for collecting samples and analysing results.

Pressure on general practice is also related to workforce and infrastructure challenges (such as buildings or systems), which existed before the pandemic and need longer-term solutions. The new primary care strategy will review work that has been going on in these areas and identify additional options for improvement.

All parts of the NHS continue to work extremely hard to meet the needs of patients, which built up through lockdown restrictions.

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