Millions of people are waiting more than a month for a GP appointment and more patients are going private. Some have given up trying to contact their NHS GP at all, a patient watchdog says, while others are going instead to overstretched A&E departments.
Private health insurers report rising demand for GP appointments. About 14.9 million appointments took place more than 28 days after being booked in the first ten months of this year, analysis by The Times found, already well above the 12.8 million such waits in the whole of last year.
The total for the year is on course to pass any in comparable records. The previous highest was 15.2 million, in 2019. In October alone 2.6 million appointments took place more than 28 days after booking, one in 13. That was almost a million more than in the same month before the pandemic, and 700,000 more than in October last year.
Separate analysis of official statistics showed 28,000 excess deaths across the UK in the first six months of this year, with the biggest rise among adults aged 50 to 64. More of them were dying early from preventable conditions such as heart disease and diabetes.
The private health insurer Vitality said that 40 per cent of claims were now for private GP consultations, up from 4 per cent in 2015, while Spire Healthcare said its network of private GPs had provided 41 per cent more appointments than last year.
GPs are dealing with rising demand for appointments but fewer full-time, fully qualified doctors to provide them. Some of the demand is due to an ageing population with more long-term problems, but GPs are also the first port of call for patients on hospital waiting lists enduring pain or poor mental health.
The latest junior doctors’ strikes, the biggest walkout in NHS history, will start on Wednesday. The prime minister has said that they will harm efforts to cut the NHS waiting list. The walkouts will run until Saturday, and again for six days from January 3.
Analysis by the IPPR think tank of the national GP patient survey this year found that about one in eight of those who could not get a GP appointment went to A&E instead, up from about one in 13 in 2021. Hospital waiting lists in England stood at 7.71 million at the end of October, down slightly from a record high of 7.77 million in September.
Steve Brine, the Tory chairman of the Commons health select committee, said: “It’s been a concern for a while to see the trend in young people in particular drifting away from NHS general practice towards often online private subscription services.
“The question for us all is, why, and is there anything that could be done to entice them back to a system that seems very analogue in their very digital world?”
The Times has uncovered a number of recent inquests of people who had struggled to get hold of their GP before they died.
Ronald Leslie Harris from Hereford killed himself in June while waiting weeks for a GP appointment to discuss mental health difficulties. Kaine Carlon, 34, was found dead at his home in Kearsley, near Bolton, in January. He had undiagnosed type 1 diabetes, and his flatmate said he had tried to make an appointment with his GP but had been unable to do so.
While most of the 34.2 million GP appointments in October took place within a week, a further 4.8 million patients faced waits of between 15 and 28 days. Of the 2.6 million GP appointments taking place more than a month after being booked, many will be for things like Covid-19 and flu vaccination, or checks that need to happen a number of weeks after surgery.
Rachel Power, chief executive of the Patients Association, said it was unclear how many long waits were clinically appropriate or based on patient choice.
Louise Ansari, national director at Healthwatch England, said GP access was the top reason people approached the watchdog, and that struggles with long phone queues or using online tools meant some patients “no longer try to book appointments at all”.
NHS and medical leaders said that problems could worsen amid falling GP numbers and suggestions that many surgeries could close. As of October, there were the equivalent of 27,368 full-time, fully qualified GPs in the NHS in England. This was 761 fewer than in December 2019, when the Tory manifesto promised an extra 6,000 GPs by 2024.
More GPs now work part-time, saying the job is unmanageable full time. A report by the Nuffield Trust said that the NHS had to train two GPs to produce one full-time family doctor as a result. In a survey by the Royal College of GPs, 37 per cent said they were unlikely to still be working in general practice in five years. Five per cent said it was likely their practice would close, or hand back its contract, in the next year.
Wes Streeting, the shadow health secretary, said: “The Conservatives cut 2,000 GPs and now patients find it impossible to get an appointment when they need one. Among those patients waiting too long for an appointment will be serious conditions going missed.”
An NHS spokeswoman said: “General Practice teams are seeing and treating record numbers of people – over a million a day – with half a million more appointments delivered every week compared to before the pandemic.
“While a significant proportion of appointments in general practice are for reviews or routine appointments for which it is reasonable that they are booked more than four weeks in advance, improving access to general practice is a priority for the NHS – which is why we’ve published a recovery plan to make it easier for people to contact their local practice, including by upgrading telephone systems and recruiting over 34,000 additional staff, as well as increasing the number of GP training places by 50 per cent by 2031/32 as part of the NHS long term workforce plan.”
A Department of Health and Social Care spokesperson said: “We are making it easier for patients to see and contact their GP. There are now 44 more appointments on average in every GP practice, per working day compared to October 2019 and the government has met its manifesto commitment to deliver over 50 million more appointments every day.
‘Ringing at 8am still gets you nowhere’
Getting a routine appointment with a GP has been “fundamentally impossible”, says Marianne, one of many Times readers who shared their difficulties (Kat Lay writes).
Their complaints range from delays in cancer diagnosis or treatment of heart problems to difficulties getting diagnostic tests and health checks.
The booking system at Marianne’s surgery is typical of many. “There are supposedly a limited number of routine appointments per day which cannot be booked in advance,” she said.
“However, even if you phone at 8am sharp these appointments have already been filled by the time I have got through and only urgent appointments remain. On some days even the urgent appointments have been filled.”
Marianne and her husband were unable to get the initial GP referral so they could not have fertility investigations or treatment on the NHS.
She added: “After crying uncontrollably on the phone to get the tests organised, a receptionist took pity on me and booked me in for a telephone appointment, despite the policy of only seeing patients for urgent matters.”
Marianne said the GP ordered the required tests “but did not discuss the problems we had been having”. Although the tests showed an issue, she was unable to discuss the results with a GP. Despite months of chasing, she never had a referral to specialists.
“The issue shown by the tests was only identified by myself and my husband — neither of us is medical — through dogged investigation and treatment options,” she said. Further research suggested an expensive over-the-counter supplement might address the issue.
“A repeat of the test in January, paid for privately, showed that this supplement had worked and I fell pregnant that very month,” she said.
Marianne said she believed her two-month-old son “wouldn’t be here if not for a receptionist taking pity on me … or having the means to pay for the supplement”.
She added: “I feel so very sorry for those who are not so lucky.”
Another reader said her 88-year-old mother had had a series of unexplained falls over the past two years but the family had been unable to get her in person appointments with a GP.
“We are offered only phone or Zoom or told to take her to A&E,” she said. “We had a paramedic out two weeks ago and he could see she had very high spiking blood pressure. He called the GP and was held in a queue for 40 minutes. He then went down to the surgery and the GP refused to speak to him.”
A GP eventually came out on a home visit but the family was dissatisfied and paid £400 for a private geriatrician who said she had had a stroke.
“He examined her for a full hour and gave a list of recommendations, which he mailed to the GP,” she said. “This was sent nine days ago. I followed up by asking for an appointment to discuss this. I am still waiting.”
