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.
