Medical student or not, everybody has had to endure the battle of booking a GP appointment at some point in their life. The 8am opening-time phone calls, the promises that really you do need to see someone today – all for an appointment that barely lasts longer than a sneeze. And that’s if you manage to get one.

In December 2018, NHS Digital published that 1 in 5 people had to wait over two weeks for a GP appointment, sparking conversation over whether GP waiting times are increasing¹. While no previous data have been released, the BMA warns that waiting times will “rocket” in future years². This is thought to be due to the increasing workload that GPs face – they saw a 16% rise in overall workload from 2007-2014³, and it’s thought this trend will continue.

What’s causing this added pressure on GPs?

Described by NICE as the “presence of two or more long-term health conditions”⁴, multimorbidity is an inevitable by-product of an ageing population. With more health conditions to discuss in a limited time slot, GPs face more pressure to strike the delicate balance of discussing issues in enough detail, while ensuring that all problems are addressed in one 10-minute appointment. Subsequently, doctors are increasingly having to advise patients to book further appointments to get the full picture. Increased patient complexity brings with it polypharmacy – the prescription of multiple medications for the same patient. This necessitates more frequent medication reviews, in the form of appointments with patients and in approving prescriptions. In a King’s Fund report, GPs described having “70 to 80 repeat prescriptions to authorise” between clinics daily, an impossible task in the available time. Along with other issues such as a decline in self-management for minor ailments and local deprivation, these place a strain on already limited GP resources⁵.

What can be done?

GP surgeries in Slough are experimenting with group consultations to increase the efficacy of appointments. In five practices, GPs and practice nurses are able to see up to twelve patients with similar symptoms in 40 to 60 minutes. This has led to positive feedback from both clinicians and patients, and crucially a 40% increase in productivity. Known ‘frequent attenders’ now attend less frequently, and clinic backlog has been reduced without reducing patient contact. While group consultations have only been trialled in diabetic patients, other surgeries have expressed an interest in what has the potential to become widespread practice in the future⁶.

A shortage of GPs⁷ has also been linked to increased pressures. In 2016, it was estimated that the UK had a deficit of 6,500 GPs, a number set to rise to 12,100 by 2020⁸. Recruitment was investigated in the Health Education England report ‘By choice – not by chance’. The report outlined that negative perceptions of general practice planted in medical students' minds was a major factor for reduced recruitment, and called for medical schools to promote a “positive…awareness and understanding of primary care”⁹.

It is clear that the current system in GP surgeries is detrimental to both patients and clinicians. While it’s impossible to drastically alter the number of multimorbidities and medications patients have in the short term, we can all make a difference by using the GP wisely. Whether that’s as a patient choosing to self-manage a minor ailment, or the government providing more funding to support surgeries, we must all treasure our GPs as vital cogs in the NHS machine. So, is my ten minutes up?

1. https://www.bmj.com/content/363/bmj.k5221
2. http://www.ox.ac.uk/news/science-blog/why-does-it-take-so-long-see-gp
3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00743-1/fulltext
4. https://cks.nice.org.uk/multimorbidity#!topicsummary
5. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Understanding-GP-pressures-Kings-Fund-May-2016.pdf
6. https://www.england.nhs.uk/gp/case-studies/diabetes-slough/
7. https://www.bbc.co.uk/news/health-46485457?fbclid=IwAR1FpokAcN2IQTXBUZ_OR6IVObrPvFt_dOAD_-rXza1LM2aMd0hKj948Wt8
8. https://www.bmj.com/content/358/bmj.j3191?sso=
9. https://www.hee.nhs.uk/sites/default/files/documents/By%20choice%20-%20not%20by%20chance.pdf