Summarising the effects of an unmet and growing demand in GP services.
Impact of Covid
The second year of the pandemic saw a surge in demand for GP services. GPs delivered more appointments than ever but there is evidence that many more people tried and failed to book appointments. The appointments that did take place were delivered in different ways, with a large proportion taking place by telephone. The outcomes of appointments have also changed: referrals from general practice to secondary care dropped during 2019/20 and remained below pre-pandemic levels in 2021/22. Despite a recruitment drive that has increased the number of GPs, the combination of growing demand, additional responsibilities, and new ways of working are worsening stress and burnout, in turn contributing to deteriorating retention in the service.
Increase in spending
Spending on general practice in 2020/21 was 40.5% higher in real terms, including Covid costs, than in 2010/11. The increase in spending followed the launch of the NHS Long Term Plan (LTP) in January 2019. NHS England spent £704.8m on Covid measures in primary care in 2020/21. Of this, £333.8m related to the vaccination programme, where GPs carried out a greater proportion of vaccinations than forecast and more affordably than in dedicated vaccination centres.
Surveys of GP patients indicate that unmet demand is substantial and has increased. In the annual GP patient survey, only 56.2% rated their experience of making an appointment as good or better in 2022, down from over 70% in 2021. Among those who avoided making a GP appointment in 2022, 26.5% did so because they found it too difficult, up from 11.1% in 2021. The way that appointments are delivered has also changed. In the year to February 2020, telephone appointments accounted for only 13.5% of all consultations. By April 2020 this increased to 47.8% and has remained high with 34.1% by phone in 2021/22.
The number of appointments overall has increased, but it is unclear if higher appointment rates mean GPs are seeing more patients. With a telephone-first approach, GPs can end up conducting two appointments for some patients – over the phone and then face-to-face.
The data also shows they are less likely to refer patients to hospitals. The proportion of GP appointments that resulted in a specific and acute referral dropped during the pandemic and have not returned to pre-pandemic levels.
The number of GPs increased by 3.4% in June 2022 compared to September 2015, but the number of patients registered with GPs grew by 8.5%. Retention has gradually worsened again, reaching 8.9% in the 12 months to June 2022. The age group with the highest numbers leaving the workforce is the under-30s, where 20.6% left the service in the 12 months to March 2022. This trend is worrying for the future GP workforce.