The above gives a snapshot of the main issues. Below is the detail, which we hope will help you to understand the challenges we are facing every day. If we had more GPs, we would have more availability but in Bristol there is a significant shortage of doctors who want to be employed by a GP practice.
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.
National Shortage of GPs: There is a shortage of GPs in many areas of the UK including Bristol. Factors such as retirement, doctors leaving the profession, and difficulties in recruiting new GPs have contributed to this shortage. The limited number of GPs means fewer appointments are available for patients.
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.
What is Birchwood doing to try and sustain its service for its patients?
Staffing: As difficult as the current environment is we are committed to recruiting more GPs to meet the demands of our patients. We have recruited a fabulous Advanced Nurse Practitioner (ANP) to provide additional support to meet the needs of the same day demand. We have a full reception and admin team.
New Ways of Working: We have piloted a Prescribing Hub 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.
Our ANP is providing support within the scope of her competence to allow the GPs to focus on the more complex cases. We continue to do telephone and face to face appointments as you have told us you do not always want to take time to travel to us during your working day.
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 a Triage Tool approved by our clinical partners so that we can direct you appropriately. 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.
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.