**What’s happening at GP surgeries?**


One of the most popular urban myths at the moment is ‘I can’t get to see my GP’: sometimes followed by ‘our NHS is broken’. Both resonate and neither is fair. So let me unravel the situation by starting at the beginning. 

 

Most of us (if we’re honest) don’t know much about how our health system works: I didn’t before I became an MP. And most of us (again if we’re honest) don’t want to know. We just want to know that our GP surgery is there when we need them. 

 

Fair enough – up to a point. Because the word ‘need’ can be very elastic and health needs especially. So let me try and summarise very simply what GP surgeries are, how they’re paid, what the strains in the system are and how we can – collectively – make best use of our surgeries or primary care, in Q&A format.

 

**What is a General Practice (GP) surgery?**

 

It’s a business partnership of more than one doctor which is effectively licensed by the Integrated Care Board (ICB), which represents the NHS in Gloucestershire, to build a list of constituents who then use that surgery for Primary Care (i.e., non-Accident and Emergency) health issues. We then access specialist services via our GP. 

 

**Are GPs employed by the NHS? **

 

No: they have been separate since the creation of the NHS in 1948, and will strongly resist nationalisation. 

 

**But they’re paid by the NHS?**

 

Yes, like a contractor. 

 

The NHS pays the GP surgery a sum each year per patient on their list. The amount was determined by what is thought reasonable for 3 x 10 minute appointments per patient per year. 

 

**Is that a ration of how many appointments we can get each year? **

 

No: there is no limit; it depends on each individual’s health. 

 

A person on the list who does not need to see their GP at all in the year helps enable the GP to see someone else with greater need more often. 

 

**So what is the average number of visits per patient per GP a year? **

 

It has shot up since the pandemic to over 7 visits a year per patient, on average. 

 

**How does this affect the surgery? **

 

Badly, because the same number of doctors (and other members of the practice team) are seeing the same number of patients much more often. 

 

**Why can’t they recruit more doctors to cope?**

 

They can a) if there are doctors waiting to be recruited and b) if the surgery can afford it. 

 

**How could a surgery not afford to recruit more? **

 

Because the surgery (as above) is paid per patient, not by the number of times they go to their surgery or by the number of doctors/nurses employed. 

 

**If everyone (on average) sees a GP more often, the numbers of patients are the same or more and the numbers of doctors is the same, then people can’t see their surgery so quickly – does the waiting list grow? **

 

It can do. On average GPs in Gloucestershire are seeing 25% more patients than they did pre-2019, they’re using technology for virtual visits where appropriate to save time and increase productivity. However, the majority of appointments are still face to face. Practices have also beefed up their IT systems so information is quicker to access, record and share e.g. with specialist consultants / the GRH or mental health services. 

 

That all improves productivity and means we get more out of the system. But it also puts stresses on individuals and the system. 


*Boxes and boxes of individual files at the GRH: a productivity improvement opportunity. *


**What does that mean in practice? **

 

Doctors have to see more patients as quickly as possible, that puts off some from becoming a GP and encourages some to become a ‘locum’ who accepts work when they want to, like supply teachers. 

 

That’s not the same as a full-time doctor, and it’s more expensive for the surgery. We have 100 locum doctors in Gloucestershire. 

 

**Can’t the surgeries and the NHS plan for how many doctors they need? **

 

They can now because the government recently agreed to a Workforce Plan (the first since 1948) as it became clear that we’ve become increasingly dependant on recruiting nurses and doctors from overseas to fill the gap.

 

**What will be the benefits of a Workforce Plan for someone who lives in Gloucester?**

 

It should enable the ICB to target their recruitment to make sure we have enough health professionals for all residents. 

 

**How bad is the gap at the moment? **

 

There are different ways to measure it, but there are seven doctor vacancies advertised in Gloucestershire practices now, and there would be more if surgeries could afford to recruit more. 

 

**Does that mean the NHS needs to give surgeries more funding to attract more doctors? **

 

Yes, one way or another. There is some currently ring-fenced funding that could, in my view, be widened. There may need to be a higher payment per constituent to recognise that some patients present more often. 

 

**Is it all about money? **

 

No: if secondary (i.e. hospital) care (e.g. cancer / elective surgery) was working as best as possible, in line with previous targets then primary (i.e. GP) care would benefit. 

 

**And what could change things longer term? **

 

The smoking ban. Currently 75,000 GP appointments a month are smoking related. It’s a major cause of lung and heart cancer. Everyone in the health sector knows this. It would be the biggest game changer that legislation can achieve for better health. 

 

**What about productivity? **

 

Yes, this is another elusive potential gain, which the government hopes will be led by IT, Artificial Intelligence (AI) and digital transformation. At its most simple, this would reduce paperwork, which (as I saw volunteering in GRH Archives) is still a constantly moving mountain. 

 

But our Hospitals Trust has also already used robotics for complicated operations, the diagnostics centre by Shire Hall is quicker and more efficient, and will go on speeding up diagnosis and treatment. 

 


*GHAC now offering GP appointments everyday from 08:00 0 20:00 to all*


**Okay all very interesting. But can I see my GP?**

 

Yes! Latest data in our city/county shows 40% of appointments were the same day and a further 25% seen within a week. For routine appointments you can (in Gloucestershire, not everywhere) book quite far ahead – which appears to increase the waiting time. 

 

But it’s also true some surgeries struggle and if demand spikes up, and a doctor is off or on holiday, then backlogs can build up and waiting times increase. 


*Very useful roundtable with GPs from 3 practices in Gloucester*


**Are you saying the ‘I can’t see my GP for 6 weeks’ phrase is not true? **

 

If one of my constituents is looking ahead for a routine e.g., age-related check-up then that is different and sensible. 

 

But it would not be right for anyone who needs immediate access to a GP, and I do not believe that is at all the situation. 

 

If anyone does have that experience, they should write to their practice manager and copy me. 

 

**What else could a frustrated constituent do? **

 

You can check your healthcare options at www.asapglos.nhs.uk or use the ASAP Glos NHS app. They can guide you step by step and provide details of services in the county, such as the GP led Gloucester Health Access Centre, open 7 days a week (08:00 – 20:00), ring 01452 336 290. NHS 111 can also book you into local services to meet your needs.

 

**Quick summary please now of the situation **

 

Big backlog post-pandemic: NHS contract for GPs out of date for scale of demand: recruitment planning needs improvement along with secondary care and technology improvements: government looking at funding flexibility and longer-term society changes (especially smoking); and GP surgeries need to be an attractive career opportunity. 

 

But there is no need for anyone to wait 6 weeks for a non-routine check-up – reality is, as so often, better than the myth. 

 

Best regards 


PS. Do let me know what your experience is at [[email protected]](mailto:[email protected]) 


**Copyright © 2023 Richard Graham MP, All rights reserved.**

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