In the final chapter, Jaimie Kaffash looks into what can be done to improve matters for practices and patients
As most GPs will attest to, it is almost impossible to improve access without increasing the number of GPs. This hasn’t stopped ministers, as previous features in this report have shown. But it is unlikely to be initiatives on the whole that make life easier for general practice staff, patients, commissioners and even ministers – instead, it is a change in mindsets. We will take a look at the ways how.
Funding basic tech improvements
One initiative that has seemed to have helped is the upgrade to telephone systems. In the 2023 imposed GP contract, NHS England announced that – from the end of 2025 – all analogue telephone systems would be banned from GP practices. They would need to move to digital telephony, which would allow routing of calls, callback and call-queuing functionality, support for remote working and business continuity and enhanced reporting of calls.
To support this move, NHS England made £240m available for practices using older systems as part of its delivery plan. This hasn’t been without controversy. Practices have warned of spiralling costs in the use of these new systems, with some claiming increased bills of £10,000 a year, with the BMA calling for the project to stop as a result. Meanwhile, there have been fears that the enhanced reporting could be used to performance manage practices.
Patients’ attitudes around contacting practices on the phone have been deteriorating rapidly, from 80% being happy with the process in 2018 to just over 50% in 2025.
Patients’ attitudes around contacting practices on the phone have been deteriorating rapidly, from 80% being happy with the process in 2018 to just over 50% in 2025. However, there has been a slight uptick in the past year. Meanwhile, new monthly data from the Office for National Statistics shows that the percentage of patients reporting difficulty in contacting their practice is decreasing.
Practices report that digital telephony has been helping. One practice manager in Blackpool says: ‘I was annoyed and reluctant to move to a new-fangled phone system when we were already on the same system as our local hospital and everything worked really well, and the system was partially compliant. We moved to our new system about a year ago and I have to say I’m impressed. We fully use the system and I didn’t have any complaints from patients, or staff, regarding the switch. It’s obviously busy at 8am but routine calls about prescriptions/results etc are moved to a quieter time in the day.’
This still needs staff, of course. One practice manager in Cheshire and Merseyside says getting through to the practice has been a ‘longstanding problem’ that has been eased by triage. But this has involved a change in staffing: ‘We now have all the staff who are in the practice from 8am on the phones – no matter what non-clinical role they have.’ It is a similar case for Jane Dalgleish, a practice manager in Stockton, who says her practice has made many improvements to GP access, adding: ‘The change we made that has had the most impact on this is to have a “spare” member of staff who is able to jump on the call queue if it is starting to rise. Sometimes this is only for a few minutes to bring the calls down to manageable levels.’
South Yorkshire GP Dr Mohammed Sharif says his practice uses AI to try to improve ease of access without needing to increase the practice team. ‘We are currently trialling an AI receptionist, who has the capacity to answer multiple phone calls at the same time and transcribe this onto Accurx for the on call doctor to review. This has eliminated any waiting times on the phone which means more patients are getting through.’
However, as is often the case with improved access in one form, there is often a trade-off elsewhere. Dr Sharif adds: ‘It is early days but this ease of access has increased the workload of the on call GP and we are going to have to review this as a partnership as it does not feel sustainable.’
Despite this, what this shows is that investing in practice infrastructure can help.
Focus on continuity and away from access
GPs believe that the focus should be on continuity of care. Our survey asked general (see methodology, below) to rank five access/continuity priorities in order of importance: routine waiting times; access to on-the-day appointments; time spent waiting on the phone; consultation type (ie, face to face or remote); and seeing a preferred healthcare professional/continuity of care. Continuity was overwhelmingly top.
Most of the comments referred to the health outcome benefits of continuity of care. For example, one said: ‘Continuity reduces poor outcomes – saves time at appointments and gives patients more satisfaction.’ Another said that ‘seeing the GP saves time and resources and we often get to a diagnosis or plan much faster’, while another called continuity ‘a vital tool in supporting good quality health care’.
There are numerous studies around the benefits of continuity of care. A 2018 NHS England-commissioned Nuffield Trust report found that relational continuity is ‘associated with a significant number of benefits to individuals and wider health systems’, including better clinical outcomes, reduced mortality, better uptake of preventative services, reduced avoidable hospital admissions and better overall experience of care. This is especially true for children, the elderly and those with long-term conditions, while vulnerable groups tend to value it more.
Meanwhile, a major study of over 10 million GP patient consultations in 381 English primary care practices over a period of 11 years by researchers from the University of Cambridge and the INSEAD Business School found that the ‘time to a patient’s next visit is on average 18.1%… longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration’.
All government and NHS plans around access mention continuity. But this tends to be paying lip service. For example, in the 10 Year Plan, there were four mentions: two as part of case studies, the other two as a consequence of the benefit of the time saved by using ambient voice technologies. The one exception to this was Jeremy Hunt implementing a contractual requirement for every patient to have a named GP from April 2015. This requirement is still in place but, in reality, is more an administrative policy.
Researchers from the University of Manchester found that continuity does often take a back seat to access: ‘In the UK, policies addressing access have favoured a simplified view of access, which focuses on the timeliness of appointments, rather than taking a broader view of the concept. The focus on speed of access has undermined other important aspects of care, such as continuity.’
Yet continuity has been decreasing. The GP patient survey reveals that the number of patients who get a consultation with their preferred GP or healthcare professional ‘at least some of the time’ among those who have one has been decreasing since 2018.
One reason for this decline is that more GPs are working less than full time. But, as sister title Pulse’s report into GP unemployment showed, this is in part a response to the pressures they are facing.
Researchers from the universities of Birmingham, Cambridge, Manchester and York – and from health think-tanks – found another reason: increasing access. They listed the ways in which this had an effect: ‘Increasing demand for appointments, itself due to demographic change, an ageing population, and increasing multimorbidity… growing use of non-GPs in primary care… and the use of pharmacies for first-contact care.’
One practice manager in Formby says appointment demands have made continuity harder: ‘The GPs’ lists have grown to the point that personal knowledge of your regulars and “old chestnuts” has gone. The triage system does help with this to some degree.’ However, she adds, flagging which patients benefit most can be tough as ‘each GP has a slightly different take on this’. The practice aims to provide continuity to palliative care patients. But, for others, she adds: ‘We do inform patients though if their issue is acute then any clinician can help – continuity is more for those more complex patients with chronic diseases and multiple co-morbidities etc.’
This is not to say access is inversely proportional to continuity – continuity cannot exist with poor access, after all. But good access does not necessarily entail good continuity, and often prevents it.
Despite these pressures around demand, many practices have managed to implement continuity policies and practice teams have reaped the benefits.
Dr Alasdair Wallace, a GP in the north east of England, says his practice has moved to a named GP system in the past year, with all patients allocated a GP and encouraged to consult with them for routine appointments. He says: ‘So far, it’s working well and has been easier than anticipated. Patient feedback has been positive. As GPs we are getting our own patients’ letters, script queries etc as often as possible. As an experienced GP I have really enjoyed the experience and it has improved my job satisfaction.’
Continuity leads to better care and, as a result, will improve access in the long run. This might make a tougher political message, but it is something that ministers must promote in the GP contract, with the removal of access targets that take practice’s attention away from good care. But this is something that will require a change in attitude – and will involve trusting GP practices.
Start trusting GP practices
The concluding solution is perhaps the hardest to achieve. But it will be beneficial for patient care in the long run. It will involve strengthening the partnership model, and allowing practices to do what is best for its patients.
The Institute for Government found that patients’ overall experience of general practice was most closely linked to a higher ratio of GPs – particularly partners – to patients. It concluded: ‘Alongside their clinical work, partners also have responsibility for managing their practices, which might suggest they would have less time to carry out appointments. But it is also possible that their responsibility for their practices is the cause of this, too: GP partners often carry out much of their administrative work outside of usual working hours, likely because they are either personally liable for the practice or are at least strongly incentivised to make sure that the practice is performing well.’
This was borne out from speaking to dozens of practices who scored highly on the patient survey and offered high than average number of appointments – many despite the structural issues working against them. The one thing they all had in common was they implemented their own unique model of access that worked for their patients. Of course, there were crossovers. But some had total triage, others had bookable appointments. Some relied heavily on other staff to carry out appropriate consultations, others were completely GP-led. Some prioritised on-the-day appointments for most patients, others encouraged longer waits for routine care.
They catered towards their patient population. For example, Dr Sarah Dixon, a GP partner in Herts and West Essex, says: ‘In terms of continuity there are those patients with ongoing/ long term conditions or an episode of illness that needs more than one appointment and they generally want to see the same doctor, they don’t want to keep explaining everything. This is the benefit of a long-term relationship with the same GP. There are others with one off issues who don’t mind who they see, they just want to be seen quickly and at a convenient time. It can be challenging juggling the needs of both of these groups of patients.’
Another GP in Essex says many patients are ‘young and healthy, with a one off issue who don’t often see a doctor and probably don’t have a strong relationship with their named GP’. They won’t want to wait for their named GP if another GP can see them sooner. Then there are the people with regular health needs or complex problems who, as one respondent said, ‘do recognise the advantages of seeing the doctor who knows them well. Often but not always older people, but including most older people’.
They did things that weren’t financially incentivised but provided good patient care. For example, the care navigators who ensured their vulnerable patients were not missing hospital appointments. Such an initiative brought no obvious financial incentive, but it was best for their patients and benefited the wider NHS. Attaching funding to something like this just makes the task more transactional. Furthermore, their emphasis on continuity isn’t due to a financial incentive. It is due to providing a better quality of care.
General practice works best where there is a happy workforce. Traditionally, it has worked on the goodwill of the staff – to try to prevent hospital admissions, to check in with a patient they were concerned about, to refrain from antibiotics when they aren’t necessary. These aren’t financially incentivised and, in the case of the latter, may have negative personal consequences in the form of poor patient feedback.
There will be greedy GP partners, as is true of every profession. Currently, patients are suffering because of the desire to prevent greedy GPs from profiting. There are more efficient ways of doing this that continues to give GPs and their freedom to do what is best for their patients. Unless we start acknowledging this, then there is unlikely to be a way for quality – and access – to improve.
Survey methodology – practice priorities
GP partners and practice manager respondents were asked to input their practice code, their practice name and their post code. Where this wasn’t clear, we correlated this information with official data from the four countries. Where this still wasn’t clear, we searched practice websites. All those without the required information after this research were removed.
For duplicate practice codes – more than one respondent from a single practice – we remove duplicates in the following order:
– Those who provided fuller information (ie, fewer blank answers and ‘don’t knows’) were prioritised;
– After this, GP partners were prioritised over practice managers;
– After this, those who answered first were prioritised.
This left a remaining 756 distinct practices. Respondents were asked: ‘Please rank the following in terms of how important they are for you as a GP practice. If you don’t want to answer this, please put “Ignore my answers” top.’ The options were: Waiting times for appointments; Time taken to answer calls; Offering on-the-day appointments; Continuity of care; Offering different forms of consultation (ie, face-to-face, remote, home visit); Ignore my answers.
When analysing the answers, those who put ‘Ignore my answers’ top were removed, leaving 756 distinct practices. We assigned a mark of 5 to the top ranked answers, going down to 1 for the lowest. Where ‘Ignore my answers’ were in second to fifth place, this answer was deleted, with those answers ranked lower bumped up. We then calculated the average.
You can find all the data and the methodology in the full report. Click here to download the full report.
Commercial partner of this white paper: General Practice Solutions
