The situation for GP practices in the UK is critical. GP practices across the country are experiencing significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and knock-on effects for patients.

The British Medical Association (BMA) provides analysis on the pressures in general practice and is updated monthly with new data. 

In addition to this the cost-of-service charges, utilities and staff wages have increased. The National Minimum Wage has gone up over 10% and in 2024 – the Government is only increasing the contract with us by 2%. That’s right – only 2%. Over 90% of NHS appointments are seen by GP surgeries, but we receive only 7% of all NHS funding.

Unfortunately, we cannot do more with less.

Below is further detail, which we hope will help you to understand the challenges we are facing every day.

Fewer doctors are looking after greater numbers of patients

At the same time, the number of practices is also falling. While many practices have entered into mergers, some practices have permanently closed. As of December 2024, 1,396 practices have closed since 2015. Factors causing this can include partner retirements, the inability to recruit staff or GP partners. 

Whilst the GP workforce has been declining, the number of patients continues to increase, demonstrating the ever-mounting workload in general practice. In December 2024, another record-high of 63.72 million patients were registered with GP practices in England, an increase of 6.82 million since 2015.  As a result, the average number of patients each full-time equivalent GP is responsible for now stands at 2,260. This is an increase of 322 patients per GP (17%) since 2015. Source: BMA analysis of NHS General Practice Workforce data. The cost of locums is too high to use them regularly and they impact on continuity of care.

High Patient Demand: The demand for GP appointments often exceeds the available supply. The growing population, an aging demographic, and increased awareness of healthcare services can contribute to high patient demand. This can result in longer wait times and limited availability of appointments.

Workload and time constraints: GPs often have heavy workloads, managing many patients and dealing with administrative tasks and home visits. This can limit the time available for patient consultations and lead to fewer appointment slots. Locum GPs can plug the gap for appointments but the ongoing admin for the patients they see returns to the GPs based in the practice.

Complex medical cases: GPs are often responsible for managing a wide range of medical conditions, including both acute and chronic illnesses. Some cases require longer consultation times or more frequent follow-ups, which can reduce the overall availability of appointments.

Outpatient Appointment Waiting Times: Outpatient and GP surgery waiting times are linked in several ways:

Referrals: GPs often refer patients to outpatient departments for specialized care or further investigations. If the waiting times for outpatient appointments are long, it can result in a backlog of patients waiting to be seen by specialists. As a result, GPs may have to continue managing these patients in their own practices until they can be seen by a specialist, leading to increased demand, and longer waiting times for GP appointments.

Follow-up care: After a patient has been seen by a specialist in an outpatient department, they may require ongoing follow-up care and monitoring. If the waiting times for follow-up appointments in the outpatient department are lengthy, patients may turn to their GPs for interim care and monitoring. This can further increase the workload and waiting times for GP appointments.

Limited Capacity: Both GP surgeries and outpatient departments have limited capacity in terms of the number of patients they can see within a given time frame. If outpatient departments are overwhelmed with long waiting lists, it can put pressure on GPs to provide more comprehensive care, resulting in increased demand for GP appointments and longer waiting times.

Patient frustration and demand: Lengthy waiting times for outpatient appointments can lead to patient frustration and increased demand for GP appointments. Patients may seek help from their GPs to expedite their referral or to address concerns arising from the waiting period. This can contribute to increased workload and longer waiting times at GP surgeries.

The Covid-19 Pandemic impacted outpatient appointment waiting times significantly as follows:

Service disruptions: To manage the spread of COVID-19 and allocate resources appropriately, hospitals had to make adjustments to their services. Many non-urgent or elective outpatient appointments and procedures were postponed or cancelled, leading to a backlog of cases, and longer waiting times.

Staff and resource reallocation: During the pandemic, healthcare providers, including doctors and nurses, were reassigned to COVID-19-related duties, such as working in intensive care units or COVID-19 assessment centres. This reallocation of staff and resources from outpatient departments to COVID-19 care further contributed to delays in non-urgent appointments.

Infection control measures: To ensure patient and staff safety, hospitals had to implement infection control measures, including physical distancing, increased cleaning protocols, and reduced clinic capacities. These measures, while necessary, reduced the number of patients that could be seen in outpatient departments at any given time, leading to longer waiting times.

Telehealth Services: To minimize in-person visits and reduce the risk of COVID-19 transmission, many healthcare providers implemented telehealth services for certain outpatient consultations. While telehealth has helped maintain access to care, it may not be suitable for all types of appointments, potentially leading to longer waiting times for in-person consultations.

Recovery challenges: As the healthcare system recovers from the impact of the pandemic, hospitals and outpatient departments are facing the task of addressing the backlog of postponed appointments and procedures. This backlog, coupled with ongoing demand for healthcare services, can contribute to longer waiting times for outpatient appointments.

Staffing: As difficult as the current environment is we are committed to recruiting more GPs to meet the demands of our patients. In comparison to our neighbouring practices, we offer more GP appointments per patients. And will be having 2 full time trainee GPs with us in Aug 2025.

We have increased the number of ARRS roles we have at the practice and provide social prescribers, mental health workers, physiotherapists, pharmacists and health and wellbeing coaches. All of these health professions provide important support to patients, and allow better access to health care.

New Ways of Working: We have an in-house pharmacy team to support improved prescribing for our patients, ensuring patients are invited for reviews to reduce the admin burden for GPs allowing them to focus on direct patient care.

We have introduced a cloud-based telephone system to help address access issues for patient.

Modern General practice: the practice took part in the general practice improvement programme which involves an agency working with the practice to review our ways of working and help streamlines process and make the surgery run more efficiently.

Upskilling staff: One of our practice nurses is now a trained nurse prescriber, which allows her to conduct minor illness clinics and prescribe some medication as needed for patient. Another nurse has undertaken sexual health training so she can fit coils and address sexual health issues with patients.

Promoting Other Healthcare Services: Accessing healthcare at the right time with the right service will enable us to focus on what needs to be seen by a GP.  We have developed our care navigation team to direct you appropriately, and increased our availability pf access online via AccuRX triage forms. This will ensure that patients who need to speak to a pharmacist or other service for advice on a minor ailment are not being seen by a GP.

We also offer late evening and weekend appointments as well as promotion of pharmacy first to patients.

Maintaining our Workforce: We have put protective measures in place to keep our patients and staff safe. There will be occasions where we simply have no more capacity to meet the demand. In these situations we will refer you to 111, and Urgent Treatment Centre or A&E as this will ensure you are treated promptly. Adding you to a long list which may not get called for several hours is not safe, effective care. We are not an urgent care provider, but we do try and support same day needs to support continuity of care – but we close at 6.30pm. It is important for patients to know that most clinical staff are here before 8am dealing with complex medical issues all day. If we support our workforce, they will not burn out and will still be there for you.

We hope that if you have read this far you will understand that we have no control over the lack of qualified GPs to recruit in the area and we are not able to shorten hospital waiting times. We hope you will appreciate the extreme moral distress experienced by a team member when they cannot give you an appointment.

Please do not say things like, “You don’t care if I die”.

We really do care.

In the simple analogy of making bread – we cannot rise together without the right ingredients.

Please help us to rise up – kindness is a free ingredient.

We know General Practice is collapsing. Every practice across England is struggling to see a way to keep its doors open, including us.

We value our patients. We know that most patients value us too, especially when they need us regularly. You know we can deal with most of your health problems, keep you out of hospital, and have your best interests at heart. The problem is with the mismanagement of the NHS. The British Medical Association (BMA) has therefore launched the GP’s are on your side campaign, because we 100% are.

Every Day Lister House Surgery provides the maximum safe number of appointments we can. Ultimately, we do not have unlimited resources and are currently working to the maximum capacity our funding allows.

We believe general practice deserves a bigger slice of NHS funding so we can train and hire more GPs, deliver the services you require and make it easier for you and your loved ones to get appointments to see your GP and practice team.

Our funding will be further reduced when the new national insurance measures come into place, along with the increase in minimum wage in April 2025.  These increases are not funded by NHS England for General practice (although hospital and secondary care will be funded) and will have a substantial effect on services we can afford to provide.  Staffing levels have had to be reduced to try and mitigate some of these costs.

We have raised the above issues with our MP Andrew Lewin when we invited him to visit to the practice and see what barriers we are facing when trying to provide the level of service you require. 

We report our demand daily to our ICB, but this has not seen any extra funding or support offered to help us meet these challenges.

You can contact our MP. Mr Andrew Lewin and raise your concerns with him as we already have.

Attend for your appointment. Last year (2024) we had 5,091 appointments wasted, due to nonattendance by patients. These appointments could have been used towards other that needed help.

Do not abuse the system. Some patients due to health conditions will need addition help from the GP, however on occasion some patients abuse the access to the health care system and use an excessive amount of time. We consider these patients frequent attenders, as they attend at high frequency rates, that are not always conducive to their condition.

Last year our top 10 highest frequent attenders of any clinician (GP/nurse/physio etc) to the practice made up 176 appointments. That is 29.3 hours of appointment time.

Our top 10 highest frequent attender of GP appointment made 124 appointments. 20.7 hours of GP appointment time.

Use our online resources. Use the NHS App or our online consultation tool for contacting and communising with us. Things like prescription requests, admin queries, sick notes, referral queries can all be dealt with online and are usually faster and more efficient than requesting a GP appointment.

Ask yourself if you really need to the see GP? There are now many other alternatives to seeing a GP for minor illness and injury, and by using these other services first, it may relive some of the pressure on the practice. These include:

Pharmacy First

Please see point 2 above

Local pharmacies offer pharmacy first. They can treat and prescribe for many minor illnesses without the need to see a GP.

Self referral

Many services will now accepts self-referral (without seeing a GP) including maternity, smoking and mental health referrals.

NHS 111

NHS 111 is a 24 hour service that can be contacted by phone or online, for healthcare advice, treatment or signpost

Urgent Treatment Centre 

An urgent Treatment centre (UTC), is a place to seek medical help for minor injuries and illnesses that are not life-threatening including coughs, colds, ear and throat infections cuts, grazes sprains and strains.

Minor Injury Unit 

A Minor Injury Unit (MIU) provides treatment for minor injuries, such as suspected broken or fractured bones, sprains and strains, burns and scalds and cuts and grazes. Patients can walk-in without an appointment. Our nearest is Herts and Essex hospital.