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The doctor will see you now

Tagged In:  Allied Health, Nursing

Can improving access to GP appointments help relieve pressure on other parts of the health system?

In a recent survey of 500 GPs and secondary care doctors, more than a quarter said they believed that up to 30% of people attending A&E should be seen in primary care. That's potentially a huge reduction in pressure on hospital doctors and nurses.

In its recent What's going on in A&E? report, the King's Fund says that it's difficult to find accurate statistics on how many people are attending A&E because they can't get appointments with their GP. However, there's no doubt about the increase in pressure on A&E departments: "Since 2003/4, the overall number of attendances has increased significantly, rising to 22.9 million in 2015/16, an increase of more than 39 per cent."

The Government believes the solution is for all GP surgeries to open from 8am to 8pm, seven days a week. In January, Hull Clinical Commissioning Group (CCG) unveiled its blueprint to create four or five GP 'health hubs', offering 24/7 appointment booking and access to an online clinician. In February, the GM Health and Social Care Partnership Board announced the approval of its £41 million scheme to give everyone in Greater Manchester seven-day GP access.

Many GP practices have introduced innovative ways of working to improve efficiency and increase capacity. For example, telephone triage systems have become widely used, usually involving a call-back to the patient by a doctor or a practice nurse to assess their symptoms before scheduling an appointment. If they don’t require treatment from a doctor, they could be referred on to another professional who could help such as an Advanced Nurse Practitioner.

Many believe that advanced technology is the answer, particularly in reducing the large number of missed consultations. Smart telephone systems and mobile apps can issue reminders and enable patients more easily to cancel appointments, saving time and money. 

Another way of relieving pressure on GPs is to make more use of the skills of paramedics, nurse practitioners, pharmacists and those in allied health jobs.  Struggling to recruit enough GPs, the Beacon Medical Practice in Plymouth has reduced routine appointment waiting times from three-to-four weeks down to fewer than seven days by using a multi-disciplinary approach. North East Lincolnshire's Minor Ailments Scheme encourages people to consult a pharmacist rather than a GP. As for those needing physiotherapy, self-referral has become common practice in many areas across the UK. This lets those needing physio get the help they need without needing to wait a GP appointment who would only refer them anyway.

According to another King's Fund survey, the number of GP consultations grew by 15% between 2011/12 and 2014/15. Over the same period, the GP workforce grew by just 4.75%. "Over my 20 years as a GP demand for appointments, and particularly their complexity, has increased beyond recognition, " wrote Dr Arvind Madan in the NHS General Practice Forward View. " We know there is no single cause for the issues we face, and that no single part of the system acting in isolation can fix it either. We need a concerted approach of initiatives, involving all stakeholders, across a number of key areas."

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