In the UK, getting an NHS GP appointment has always been a trial in great patience and a little luck. Since the start of the Covid19 pandemic, the routine frustrations became far worse and continue to put patients at risk. Now, the Tory government have claimed they’ll be ending the 8am scramble to get a doctor’s appointment, but will it work?
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The Great NHS Healthcare Debacle
It’s Not All Rainbows
The NHS is undoubtably a wonderful concept in theory and has been a literal lifesaver for countless people ever since its inception in 1948. The problem comes when severe mismanagement, ignorance and politics take over, leaving patients to pay the ultimate price time and time again. The issues are across all levels, from the government, NICE and upper NHS management, to individual nurses, doctors, surgeons and specialists. It has been, for a long time, quite unpopular to discuss openly the negatives about our NHS or the bad experiences we’ve had. Many people will undoubtedly have some great experiences, but so too will many have had terrible ones. There’s no getting around the fact that the NHS isn’t all rainbows.
Nurses, ambulance workers and junior doctors have all been on strike after the “cost of living crisis” really kicked in during 2022 and 2023, leaving the “do no harm” ethic firmly behind them. It doesn’t appear to be so much about ensuring staff have a liveable wage when many admins are earning far less, but about getting what one is “worth”, no matter the cost to the patients. What was once a job not about the money but about helping people has cynically turned into a financial and political circus. Some would argue that this isn’t a role done voluntarily out of the goodness of someone’s heart, that it’s a job, with a salary and a pension and more security than many employees get outside of the NHS. The matter of poor working conditions and difficulty getting into training seem, to me, more pressing than what some would consider an already reasonable wage.
But the problems in the NHS go far behind the pay scales. Medical staff getting a small percentage increase and a one-off lump sum now is not going to attract a stampede of medics from across the world to flock to the UK to work, nor is it going to convince the UK population to sign up for medical school.
With waiting lists at an all time high and being made worse by strikes, and with A&E departments overrun to the point where they keep Tweeting about how you shouldn’t go to A&E, patients are getting desperate and beyond disillusioned about their healthcare system actually giving a damn about them.
With GPs in England earning an average salary of around £111,900 at present, the pay is one appealing element of becoming a general practitioner. During the 3 years training prior, they can earn an average salary of £49,000. A problem comes when many GPs are working part time, with the numbers of full-time doctors continuing to decline despite demand continuing to rise.
This may be because the wage is enough that some doctors can partly retire, some may have family commitments, some may want to improve their work/life balance and so on. Some GPs, and indeed some doctors and nurses in hospitals, moonlight for private firms as agency workers to earn a far greater amount while working only two or three days a week in their NHS practices.
Flexible working arrangements are definitely beneficial and appealing for staff, but it’s perhaps not helping the situation for extensive waiting lists and lack of appointments available for patients.
Then of course come further complications, like training being inaccessible, Brexit apparently reducing numbers of staff from outside the UK, other countries offering a better working/life balance, and so on. None of it adds up to increasing the number of doctors and appointment availability.
Struggles To Get A GP Appointment
To deal with minor or potentially life-threatening issues, patients turn to their local GP practice. Or at least they try to. But practices have pushed for online forms to be filled out instead of using the phone. Then they say there are no face to face appointments available, but nor are there any telephone slots available for booking. You’ll have to call back at 8am tomorrow and they’ll give you a same day slot. If you’re lucky.
Cue the 8am scramble, eyes on the clock and finger poised to press call the very second it reaches the hour. Then you’re sitting through over a minute of pre-recorded waffle that you typically can’t cut through anymore no matter how many times you jab the hash key. Then you wait, listening patiently to the grating music and hoping there’s still an appointment left by the time you’re up.
Then you hear something that makes your heart sink. “You’re caller number 16 in the queue”. How did so many people get in before me when I called bang on the second it turned 8am? Do they know some shortcut I don’t? You’re almost hoping someone presses to hang up by mistake just so you can get through. What a monster.
The NHS Making A Quick Task As Circuitous As Possible
Has anyone else noticed that the NHS, while overrun and all too busy, quite likes making things as difficult, circuitous and long-winded as possible? It’s illogical, not to mention angering when it’s the patients who often get the blame for the high wait lists and strain on the NHS. There are too many old folks, there are too many smokers, there are too many drinkers, there are too many hypochondriacs.
One app becomes several and counting. One website becomes many and varied. One call becomes various other more complex routes. One appointment becomes a formidable affair that patients are too exhausted to take on.
When it comes to merely making an appointment, you’d think it’d be quick and simple. One phone call and you’re booked in to see your usual GP. Except most patients don’t have a ‘usual’ GP anymore. You’re to see whomever is available and be grateful for it, even if it means they’ve no knowledge of your medical history and you have to waste the appointment re-telling your story. And of course one call or pop to the practice has been shunned in favour of several additional hoops for the patient to jump. Why be quick and easy when you can make it as tiresome and difficult as possible?
During the pandemic, many practices told patients to use an online triage form. So if you call or go into the practice and ask for an appointment, they’ll direct you to a website, where you need to fill in various boxes to explain the issue. I’ve found after a few times of doing this that doctors never seem to actually read what I’ve spent half an hour filling out. “What have you come in today for?” And here I go, explaining it all again.
The forms are received by reception, who pass them on to a doctor. The doctor may either message the patient directly or they’ll message reception with a response, and reception contacts the patient. This is to ensure the silly peasants – ahem, patients – don’t go asking for an appointment if they don’t really need one, or ask to see a doctor when really a nurse would suffice. Like the time I asked for a doctor when I had a chest infection and was instead sent to a nurse, who told me to put my head over a bowl of hot water and refused to write a prescription, not that she was allowed to as a nurse. I then had to beg to see a doctor, who prescribed steroids and antibiotics. A waste of an appointment and more time for me struggling to breathe but hey, the practice always knows best, right?
I remember the time I was in the GP waiting room and a woman came in to ask for an appointment. She was told to use the online form. The patient said, “But I’m standing right here, could you not perhaps do it now?” Nope, the receptionist was having none of that. And it’s not her fault if her orders are to ignore patients and point them to the online form.
So this woman tries to get the website up on her phone, except the internet isn’t working. There’s no working wifi today, but no worries, she’ll pay over the odds and turn on her 3G if it’ll only take a minute. What she wasn’t told was that it doesn’t just take a minute. She also wasn’t told the website wasn’t actually working that day either. She spent 10 minutes, paying through the nose for her mobile internet, not being able to get the site to work properly, and the receptionist simply encouraged her to keep trying. Another 5 minutes go by and she’s getting really frustrated now and I want to speak to the receptionist on her behalf, but I resist and instead try a laser beam stare in her direction, trying to implore her to help the lady.
Eventually, just as I was called in to my appointment, another member of staff came in and mentioned that the online triage form wasn’t currently working. No shit. The poor woman then has to go back to the receptionist for her to book the appointment, which was all she wanted to do half an hour ago.
“Call Back At 8am”
If you need help for a medical issue that you can’t meditate away or get resolved through the pharmacy, you need to see a GP. If you want an appointment, and one that’s not a month or two away, you’ll need to joint the 8am stampede and keep your fingers crossed. If you don’t get a slot, better luck tomorrow. It’s an expensive game for those without a mobile contract with inclusive minutes, too. When on PAYG, I realised I’d been spending £8 a pop some calls just trying to get appointments for myself and my parents. A rolling one-month SIM-only contract is the only way to not bankrupt yourself.
Obstacles like the online triage forms and long pre-recorded telephone messages have worn patients down. It’s not so much a patient centred approach as it is a practice-led defence procedure to reduce appointments, cut face to face visits and frustrate patients to the point where they give up and decide the only option is to suffer in silence at home.
Some practices have prevented patients from making appointments for the future. By ‘future’ I mean any day that’s not that same day. This happened even prior to the pandemic. On other occasions, there are appointments that technically could be booked but the wait is either over a month or there’s just nothing actually bookable, so it’s back to square one of having no appointment.
Then there’s the issue of telephone call / video chat or face to face. Many patients have been unable to get in person appointments for a long time now. You’d think once the government and NHS brushed the pandemic under the rug that it would go back to business as usual, but no such luck. The pandemic has been helpful for local CCGs/ICB to implement new guidelines to remove patients from treatments and free up nurse appointments. It has been helpful to push for less contact between patient and practice. It has been helpful to encourage more telephone and video calls rather than seeing doctors face to face. It has been helpful as an excuse, blaming Covid for the dire situation we find ourselves in with our healthcare system.
Proposed Changes To End The 8am Scramble
To sum up, at present many GP practices will only allow patients to get an appointment by calling at 8am and hoping they’re lucky enough to get a same day slot, whether that’s on the phone or in person. Some practices allow for booking in advance but it’s often very restricted with long wait times of a month or more, or no availability at all because the booking system doesn’t go far enough into the future.
The proposed changes come into effect because of the new GP contract stipulated by NHS England for 2023/24. This comes into effect on 15th May 2023.
Under the new NHS contract, GP practices must allow patients to book appointments in advance, offer an on-the-spot assessment or refer them to another service, like a pharmacist or specialist.
This means that receptionists will no longer be able to tell a patient to call back at 8am another day if there are no same-day appointments available. Whether patients can if they wish is another matter. The practicalities of this new plan for patients aren’t yet known.
Another part of the contract has apparently seen the key targets that GPs need to meet being cut from 36 to only 5. One of the targets in place is to ensure patients who need an appointment in the next two weeks will actually get one. You’d think that reducing targets would be received positively by GP practices, but it seems many aren’t too happy at being told their patients should actually get the appointments they need.
NHS England sent a letter to all NHS GP practices in March, stating the following : “To ensure consistency in the access that patients can expect, the GP contract will be updated to make clear that patients should be offered an assessment of need, or signposted to an appropriate service, at first contact with the practice… Practices will therefore no longer be able to request that patients contact the practice at a later time.”
Furthermore, there’s talk of the updated NHS app offering some patients the chance to book private appointments.
But what all of this really involves in reality is quite uncertain. The “assessment of need” is, presumably, to be undertaken by a doctor in person or on the phone to see whether the patient should be offered an appointment. If so, that’s not too much different to the current system.
Mixed Responses To Greater GP Appointment Access
GPs are apparently considering striking over these new changes that are designed to end the 8am scramble. Having no doctors available is certainly one way to end it.
Practices have hit back at not having additional financial input, staffing or other resources to action the new contract. The BMA’s GP committee’s acting chairman, Dr Sharrock, referred to this new contract as a “slap in the face of hardworking GPs and patients across the country.” He went on to say “To offer nothing to meet the spiralling costs of running practices as inflation runs rife, and teams continue to do more with less, is insulting to staff and unsafe for patients.”
However, NHS England’s Ursula Montgomery has noted a few changes being brought in over the next year, such as a greater focus on preventative care for the likes of heart attacks and strokes, and the accessibility of medical records online and through an app to reduce calls into practices. NHS England want the current app to be expanded to become a smart service that’ll be known as NHS Gateway. Many patients will be letting out a sigh at reading this. More apps and wasted money, when all we want are decent doctors and the chance to actually be seen by them.
She also explains: “Frontline teams will be backed by greater funding to expand their teams, with more mental health practitioners, advanced practitioners, and apprentice physician associates joining the workforce, combined with changes to ensure staff spend less time doing paperwork and more time with patients instead.”
So there will apparently be extra funding to expand staffing, if only the staff can be found. A £246 million pot is being made available to improving patient experience when it comes to contacting their GP practice and ensuring they get an appointment within a fortnight. This is part of a larger £6 billion – yes, billion – “rescue package” to ensure these changes can be made across the country.
The responses within the medical realm haven’t all been negative. The chair of the Primary Care Network’s advisory group has said that “primary care leaders support the ambitions of the contract and the increased focus on improving access for patients.”
One problem patients have been facing for years now is that they want and need to see a doctor but can’t, so whether this contract will result in a greater chance to see a doctor or not is yet to be seen. In reality, it’s hard to see how it will when there’s no plan for generating more appointment slots. Echoing the concern, the director of Silver Voices, a campaign group for the elderly, has said the following: “The end of the frustration of being asked to call back, after queuing to get through to make an appointment, certainly represents progress but it is no guarantee of a timely face-to-face appointment with a GP.”
Less Scramble, But Not Necessarily More Chance Of Seeing A Doctor
It seems the new contract is attempting to move things forwards towards a more integrated, supportive healthcare service that puts patients back on the list of priorities. With many doctors and their unions taking umbrage at the thought of having to see or speak to more patients, even more strikes may loom. Patients may not be rushing to call at 8am, but they may not be any more likely to get an appointment in good time. With the way I was routinely fobbed off by doctors for several years, my mum always said I’d be better off going to a vet. Let’s hope there are plenty of vets with open appointments as patients may need to take drastic measures if this latest plan doesn’t work.
Have you struggled to get a GP appointment in the last few years? Have you been an unwilling participant in the 8am scramble?