There are a number of underlying factors which result in a demand for appointment significantly outstripping what we are able to offer.
A significant growth in our practice population
In 2010 the Humbleyard Practice, which comprises of Cringleford, Hethersett and Mulbarton surgeries had a registered patient population of 14,000. Large housing developments in our practice area has led to the registered patient population increasing, as of January 2023, to 22,000. This increase of 8000 patients over the last 13 years had led to us being the 4th largest practice in Norfolk (total of 104 practices) and the 228th largest in England (total of 6375 practices). There are 43 GP practices in Norfolk which have a registered population of 8000 or less, illustrating that we have essentially had to absorb a patient list comparable to the total patient list size of many other surgeries in Norfolk.
Unfortunately prior to developments being approved there is very little consultation with primary care services to ensure they can meet the demand of the increasing population.
With ongoing local housing developments we are anticipating another 3000 patients being added to our practice population in the next 3-5 years.
The pictures below show some of the recent housing developments.
More complex patients
With an ageing population, longer life expectancy and increasingly sophisticated medical treatments, patients who present to primary care are much more complex. We look after a number of care homes and have had assisted living developments open within our practice area. Our clinical systems allow us to analyse our patient mix and it is clear that the proportion of complex patients in our registered population is rising. Patients who fall into this category will need input from the GP services more frequently, sometimes necessitating multiple appointments per week. This is imperative to ensure safe care is provided. We can only provide a finite number of appointments per week and therefore this puts a squeeze on how many appointments are left to offer.
It is likely that the proportion of complex patients will increase further in the next 3-5 years.
Not enough GPs
Currently there are about 27,300 full time equivalent (FTE) GPs in England. In 2015 this was around 29,000. The NHS has lost the equivalent of 2,059 full-time fully qualified GPs since 2015 at a time when more GPs are required.
This is national problem and it is well publicised that the GP workforce hasn’t increased to meet the demand of the population. Unfortunately due to the stress of the job many GPs are changing their roles or retiring early. It is very difficult to recruit new GPs and this shortage means we can struggle to provide an optimal level of appointments. It also means each GP takes responsibility for more patients which unfortunately can exacerbate workload stress and burnout.
If you want to read more about this trend and look at more data please look at the following link:
Long hospital waiting lists
Due to a number of factors, including COVID-19, the waiting list for hospital appointments and operations has lengthened significantly. The Norfolk and Norwich Hospital do publish their waiting lists and you can find this information here.
The wait for the vast majority of specialties is between 6 and 18 months.
Whilst patients await specialist care, they continue to have symptoms and often these deteriorate whilst they wait. This results in patients consulting with their GP more frequently during the wait period. We also receive daily requests to try and expedite appointments. If the waiting lists were reduced more patients would have their needs addressed by the hospital services resulting in less pressure on primary care. Unfortunately it may take many years for this situation to improve.
What are we doing to try and meet the demand
Expanding our workforce
Although recruiting GPs is difficult, we have been fortunate enough to welcome a number of other fantastic, highly skilled individuals into our team. This includes advanced nurse practitioners, physicians associates, emergency care practitioners, outreach nurses, physiotherapists, pharmacists, mental health worker and social prescribers. This skill mix provides a number of pathways which can be offered to patients when they contact the paractice.
Care navigation
With a finite number of appointments available, is it imperative that each appointment is used appropriately. We have highly trained care navigators who work in our appointments hub. When a patient contacts the practice, one of our care navigation team will ask some appropriate questions to understand the underlying concern. The team member will then consider which of the many various options available would best suit the scenario. If we are at capacity then the care navigator will be able to advise you on the options available. The team are supported by the GPs in the practice.
Use of online services
We are using our online consultation tool PATCHS to provide easier access to the GP surgery appointments and services. This service is provided by an external healthcare company and functionality will be added over the coming months.
Proposed new surgery
We are actively looking at options to expand the GP surgery buildings. We often run out of available rooms in the practice and new premises will allow us to provide more clinical services on a daily basis. Please note we are in the early stages of this process with the NHS Estates team.
Working with our Patient Participation Group (PPG)
We have active PPGs and have regular dialogue with the PPG members to outline the pressures on the system and listen to patient feedback on how the services could be improved.