More than 25% of GP appointments avoidable, new report reveals

About 27% of GP appointments could potentially be avoided if there was more coordinated working between GPs and hospitals and wider use of other primary care staff, a new study by the NHS Alliance and the Primary Care Foundation has revealed.

The report, titled Making Time In General Practice, also called for better use of technology to streamline administrative burdens and wider system changes, saying these too will ease the burden on overworked GPs.

The report was overseen by a steering group including the Royal College of GPs and the BMA GPs’ Committee.

It also found that a significant amount of GP time could be freed up if family doctors were not having to rearrange patient’s hospital appointments and chasing up test results from local hospitals. Such activities accounted for 4.5% of appointments in the study area and, if replicated across England, would account for 15 million appointments.  

Additionally, an estimated 1 in 6 of the patients in the study could be seen by another professional in the wider primary care team, such as clinical pharmacists, practice nurses or physician assistants.

The report states that:

• 6.5% of appointments could be seen another professional within the practice
• 5.5% of appointments could be handled by community pharmacy,  or the patient could be supported to deal with the problem through self-care
• 4% of appointments could be dealt with through social prescribing/navigation.

In July, NHS England launched a £15 million scheme to fund, recruit and employ clinical pharmacists in GP surgeries.

The study argues that the reduction of bureaucracy in general practice should be made a national priority; freeing up time for practices to work together and improving communication between general practice and hospitals.

It also calls for streamlined payment systems that GPs use, to simplify and speed up how much time practice managers spend on entering data. 

Immediate practical steps to cut down on bureaucracy suggested by the report include:

• Patients who are unable to attend a hospital appointment should be able to re-book within two weeks without going back to the GP. Booking and rearranging hospital appointments should be simpler without the patient needing to go back to the GP
• Practices should employ a wider range of staff within the practice team, with the decision on the type of staff left to the discretion of individual practices and federations
• NHS England will work with doctors to streamline communication, particularly between hospitals and practices, and reduce the workload of processing information within practices
• Practices should free up time for GPs and other leaders in the practice to think through how they can work differently, learning the lessons from the PM’s Challenge Fund sites and the Vanguard sites as they become available – creating the ‘headroom’ needed to plan new ways of working and clinical innovation
• GP federations should be funded to work across their practices to build practical social prescribing projects that offer real alternatives to taking up GP time with patients whose needs can be better met by other kinds of support in the wider community.

Dr Jonathan Serjeant, GP, Co-director and Co-founder of Brighton and Hove Integrated Care Service and National lead for NHS Alliance’s Accelerate programme, argues that, given today’s standards of IT, patients should be given more control over their own patient records rather than this burden staying with GPs.

“GPs and their colleagues are experts in listening, supporting and diagnosing their patients. This is what we’ve been trained to do, and what we want to do,” he said.

“If applied quickly, the recommendations set out in this report, particularly those around extending the GP team to incorporate other health professionals, will help reduce the current levels of bureaucracy GPs face on a daily basis.

“The end result is that GP time is freed up, and people have access to all their information whenever they need it.”

Rick Stern, Chief Executive of NHS Alliance and a Director of the Primary Care Foundation, added: “This report documents how general practice is struggling with an increasing workload and the urgent action required to relieve this burden. We want to ensure that GPs and their colleagues in general practice are freed up to deliver the job they were trained to do and care so passionately about.”

Dr Robert Varnam, Head of general practice development for NHS England, said: “General practice is the bedrock of healthcare and NHS England commissioned this report because we are determined to support GPs in reducing the pressures they face. The findings include helpful suggestions which should free GPs to spend more time with patients most in need and further ways to reduce the administrative burden.”