Access, access, access!
It seems wherever I turn, the only metric that concerns anyone about general practice is access!
How I absolutely loath that word, because it’s broken colleagues. GPs lie awake at night trying to work out how to deliver unlimited access with limited (and dwindling) resources.
Let’s look at March 2025: 31.4 million appointments in England, 44% same-day, 64% face-to-face. That’s 6.5 appointments per person, per year.
And still, we’re told: “Access must improve.”
Fewer GPs, more patients! “Access needs to be improved.”
Even as staff burn out, buildings crumble, and patient complexity rises. “Access has to improve.”
Access, damn access!
Where’s the Holy Grail? How can this impossible mismatch between actual and realistic capacity and the ever-increasing demand for Access be resolved? Apparently: Technology!
“Let’s invite everyone to send in their requests via apps, texts, portals…”
In February, 2.7 million clinical e-consults were submitted. That’s a 7–10% workload increase, with zero extra resource. These don’t even count as work to the NHS – unless you book them as appointments.
Yet the new contract in England mandates more e-consults from October.
But guess what? There is no extra resource, no new money, yet no capacity limits on this extended access.
It turns out there IS a back door into general practice that will allow unfettered access, without any consideration for capacity.
e-consulting may have a role in general practice, but it cannot and must not be viewed as a simple add on to existing access pathways. It has inherent risks and workload implications and must be properly accounted for and resourced.
I would note that by default, e-consultations risk being discriminatory for those who do not have access to the required technology, or the knowledge, ability, and capacity to use it.
The relentless pursuit of providing more patient contacts with the same finite pool of GPs is no good for patients either. They find themselves bundled into an appointment with their exhausted GP and then out again before they have had the time to feel like their concerns have been heard.
The GP in turn is robbed of the most satisfying part of the job – getting to understand the whole person and their health needs.
Then what does this dissatisfied patient do afterward? Quickly seek another appointment so they can have a further go at explaining their health concerns, and so the spiral of access at the expense of quality turns further downwards.
We need quality over quantity, I trust that many of my patients would be willing to wait a little longer for a high-quality appointment, where they and their GP have time to speak and listen properly. Diverting more time into uncapped and unfunded e-consults puts this goal further out of reach.
We should close this back door, or at the very least, ensure that all the activity coming through it is resourced.