Shortage of 800 Scots GPs 'is the real reason for a lack of appointments'

By Dr John Ip

General practice is under huge pressure.

I am reading, almost daily, media reports of GPs “refusing” to see patients face-to-face and I cannot stress just how damaging that is to the profession.

It is simply not true: we are – and have been – seeing patients face-to-face every day, examining, investigating, advising and treating where it is both appropriate and clinically safe for both patients and staff.

A typical day at the practice for me right now would be up to 50 and sometimes even 60 patient consultations. These would be a mix of face-to-face and telephone consultations along with home visits to our palliative care and housebound patients.

On top of direct patient contact, there is the prescription requests that needs to be done too, and on busy days, I can have over 50 special requests for medicines. Adding in hospital and clinic letters, and tests results which need to be read and actioned, a full day at the practice can spill over into the later hours when I log into the practice at home to finish the day’s work.

The number of consultations I am carrying out has skyrocketed. The European Union of General Practitioners has stated that 25 consultations per day is sustainable for GP workload. In 2019 a typical working week for me consisted of 106 consultations on average - around 30 consultations a day with some protected time for admin and practice audit.

Unrestricted booking of face-to-face appointments would mean full waiting rooms – in small waiting rooms that are poorly ventilated the risk to elderly and vulnerable patients is too great, and therefore the restrictions need to be kept in place for now. Face-to-face appointments need to be spread out in order to avoid there being too many people in waiting rooms at any one time – so in turn that means fewer appointments per day, that need to be prioritised for those with the greatest clinical need.

Another inevitable effect of opening up unrestricted booking of face-to-face appointments will be significant waiting for appointments with the loss of the ability to clinically prioritise those most in need. We cannot be both seeing patients face-to-face and be available for telephone consultation at the same time.

GP teams want to see our patients again – it’s what GPs, practice nurses and health care support workers are trained for. Remote consultations may be convenient for some patients in the sense that they do not need to leave their homes, but they are stressful and take additional time to gather information and give patients advice – believe me when I say it’s not something we’re desperate to hold on to, but the need to maintain a safe environment for both staff and patients is paramount, as well as to prioritise those patient that need a face to face appointment for clinical reasons.

We are also desperately short-staffed across the board. We need more GPs to cope with the increasing workload demands. The Scottish Government has pledged to deliver an additional 800 GPs by 2027: I do not believe, at this stage, they are on target for that – and we also need those 800 GPs to be whole-time equivalent, not simply headcount.

Please know we are doing our very best with very limited resources, and we want to do everything we can to help you, but we cannot promise face to face appointments for everyone right now. We have systems in place to prioritise patients on clinical need – we know how to manage clinical risk and I believe that we will weather the current storms of pressure, but like everything in the NHS right now, it will take time.

* Dr Ip is the GP Partner/Medical Director of the Glasgow Local Medical Committee and member of BMA Scotland’s GP Committee

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