More than a quarter of patients who need appointments avoid making one because they find it too difficult, according to a new survey.
The NHS GP Patient Survey 2022 showed a sharp rise in people struggling to get through to GP practices over the phone. Since last year, the share of respondents saying it was not easy to make contact with anyone jumped by nearly 15 percentage points to roughly 47% in the previous 12 months.
Social media is full of memes about the obstacle of a GP's receptionist and the struggle of the 8am phone queue for a same-day appointment. But behind the humour is falling patient satisfaction and a growing struggle to access what is, for many, the first port of call for medical help, revealed this year by the survey.
READ MORE: People wait days for out of hours GP services amid staff shortages
Dr Omon Imohi, a 39-year-old GP in St Helens, said "there's this notion that the GP receptionists are difficult to get through, but they can only offer what's there, they can only give what they've got". She worries about taking toilet breaks while trying to get through 18 face-to-face and remote consultations a day, on top of administrative work like processing prescriptions, blood test results and hospital referrals.
She squeezes in extra appointments for people with urgent needs when she can, but there's a limit how far any GP can stretch. Dr Imohi, who is also vice chair of the Royal College of General Practitioners' (RCGP) Mersey branch, told the ECHO: "[Receptionists] feel the frustration as well, because patients are shouting at them, sometimes patients are insulting them, but it's not within their power."
The pandemic saw GP practices shift to online booking systems and phone consultations, some of them almost overnight. For older, poorer and less technologically savvy patients, this presents a barrier to accessing medical advice as they may lack the knowledge or resources to navigate the process.
A common experience now is jumping on the phone at 8am in the hope of beating the queue for an appointment, then waiting for a callback for phone triage before getting an in-person appointment, although these are still less common than pre-pandemic. Some slots are set aside for routine appointments booked days or weeks ahead, while others are reserved for emergencies in need of same-day attention.
Roughly 53% of respondents to the GP Patient Survey found it easy to get through to their practice by phone, down from 68% the previous year. Just more than half said they got an appointment at a time they wanted or sooner, down from 59% the 2021. According to the Department of Health and Social Care (DHSC), 44% of appointments, excluding Covid-19 vaccinations, took placed on the same day, while nearly three quarters were within seven days.
Dr Gary Howsam, vice chair of the RCGP, said: "The real issue is that we have a huge shortage of GPs, and our workforce is no longer big enough to manage the needs of an ageing and growing patient population with increasingly complex needs. This was the case before the pandemic and it has only been further exacerbated by the events of the past two years."
A spokesperson for DHSC said there are "now nearly 1,500 more doctors in general practice than before the pandemic". But there's the equivalent of 1,622 fewer full-time GPs treating greater numbers of patients compared with 2015, with the average GP working nearly 20% fewer hours, for a total of 38.4 per week, than in 2000.
The NHS lost 743 GPs in the year from March 2021 to April 2022, according to the British Medical Association (BMA), and nearly half of current GPs plan to retire by 60, mostly due to burnout, a survey by GP magazine, Pulse, revealed. Meanwhile, the population continues to grow, age and become sicker, leaving GPs with 16% more patients, roughly 300, than they did in seven years ago.
Dr Imohi said "the problems that were there before [the pandemic] are still there", but piled on top of a staffing crisis and climbing waiting lists, are the disruption of the pandemic and the growing difficulty securing GP appointments.
She faces increasingly complex cases, with conditions getting worse and new ones emerging by the time patients see a doctor. This is getting so bad, she's had to increase the standard length of many appointments from 10 minutes to 15, to provide enough time for a proper consultation.
Dr Imohi, who herself struggles to get an appointment with her own GP, said: "By the time [patients] are seeing you, you're wondering, 'Oh, why didn't you come earlier' and they're telling you, 'I've been trying for the past three weeks, I've been calling every morning and they just tell me to call at eight o'clock in the morning'.
"Sometimes, by the time they call and they've been on the queue for a while, by the time it gets to them, the appointments are gone, because while they're on the phone, some patients come in through the door and book the appointment face-to-face.
"There are not enough doctors, there are not enough clinicians. Even if you had five GPs in the practice of maybe 12,000 patients, we can only see so many in a day. Once those appointment slots are filled up, it's difficult. We might be able to see a few emergencies or extras, but there's a limit to how many we can see."
More than 4,000 trainees accepted places to begin GP training in 2021/22, according to the NHS's Health Education England. This is a "record number", according to DHSC, but this specialist training takes three years, meaning doctors and patients won't see the benefits until 2024, when the department hopes to have created 50m extra GP appointments
Patients still overwhelmingly trust health professionals when they do see them, according to the GP surgery, the share of respondents saying they had a good overall experience at their GP practice was 72%, down from 83% last year. Satisfaction with GP services is lower among younger age groups and more deprived groups, along with some ethnic and religious minorities.
On July 1, an integrated care system, NHS Cheshire and Merseyside, replaced Cheshire and Merseyside Health and Care Partnership. It aims to bring partner organisations together to improve health outcomes, tackle health inequalities, and increase productivity and value for money.
A spokesperson said: "The results of this recent patient survey show the scale of the challenge we face nationally and locally around ensuring people get access to the services they need. Nationally, we note, the survey shows the most significant drop in patient satisfaction with regard to access to GPs, either through phone or face-to-face appointments, as well as out of hours services.
"Although Cheshire and Merseyside perform better than the national average in many areas, we are utterly committed to doing more. When patients do consult with their GP, it is encouraging to see that satisfaction levels remain extremely high in the trust and confidence people have in their GP - 94% satisfaction - again, above the national average.
"Covid is still part of our daily lives and has certainly had an impact on GP services. Our GPs are actually having more daily contacts with patients now than they did before the pandemic. And this is testament to the hard work and innovative thinking across our system.
"We are already making use of the information provided in this survey to improve our offer where we can and share best practice with colleagues. We have some exceptional examples across Cheshire and Merseyside where satisfaction is significantly higher than the national average, and also some areas where it is lower."
Dr Howsam of RCGP said: "GP teams are working flat out to deliver increasingly complex care to the rising numbers of patients that need it. More consultations are consistently being delivered every month than before the pandemic, and nearly half of these on the same day they are booked.
"But while the complexity and intensity of GP workload is ever-growing, the number of full-time, fully qualified GPs is falling and we simply don’t have the time or resources to deliver the type of care we want to deliver for our patients.
"Our patients – and our GPs and practice teams - deserve better. That's why the College has launched our Fit for the Future campaign calling on government to address the spiralling workload and workforce pressures in general practice.
"We want urgent action to improve patients' experiences, including investment into IT and booking systems, alongside a new recruitment and retention strategy that allows us to achieve and go beyond the target of 6,000 more GPs. We also need to see a reduction in unnecessary bureaucracy, so that GPs can spend more time delivering care to patients.
"The findings from the latest Patient Survey must not be used to criticise already-demoralised hardworking GPs and our teams, but to serve as a wake-up call to politicians and policy makers that GPs must be appropriately supported so we can deliver the best possible care to all our patients when they need it."
The Department of Health and Social Care said it made more than £520m available for improving access and expanding GP capacity during the pandemic, in addition to the £1.5bn it announced in 2020 for extra GP appointments.
A spokesperson said: "GP teams are working incredibly hard and in June they delivered over 26 million appointments, including lifesaving Covid jabs. We are creating an additional 50 million general practice appointments by 2024 by increasing and diversifying the workforce."
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