Supply, in the form of access to GP services, changed rapidly and dramatically during the pandemic

7 May 2021

I thought the concept of supplier-induced demand was simple; when supply increases, demand increases. But health economists define it in a more sophisticated way, as the amount of demand that exists beyond what would have occurred if patients were fully informed.

This is relevant to general practice as we emerge from the pandemic. Supply, in the form of access to GP services, changed rapidly and dramatically during the pandemic in order to control the spread of infection. Some people didn’t like the reduced access to face-to-face appointments, but many patients have found it easier to access professional advice via the telephone or through digital triage services.

From a patient's perspective we should celebrate better access to care, but as society opens up, we’re beginning to see the consequences - supplier-induced demand in which some patients, unaware of the implications, are seeking professional care for problems which they would not previously have brought to their GP, or for which they are seeking care earlier. This is increasing the pressure on an already over-burdened service.

There’s a legitimate public debate to be had about a demand-oriented health service and the implications for inequalities and workload of having one. But right now we’re barely providing enough resources for a needs-led one. Politicians have a responsibility to engage the public with this reality.

Latest updates from your College

Vaccine-status certificates

News just in and we're really pleased to see the latest public guidance from the Department of Health and Social Care on how people can demonstrate their vaccination status explicitly stating: "Do not contact your GP surgery about your COVID-19 vaccination status. GPs cannot provide letters showing your COVID-19 vaccination status".

It appears that from 17 May, people will be able to show their vaccination status via the NHS App - but we’ve been assured no burden will be placed on GPs or your teams to facilitate this.

We’ve been very clear with Government and policy makers that any introduction of vaccine-status certification should have zero impact on what is already 'undoable' workload in general practice, and it’s good to see they've taken our calls seriously.

You can read the submission we made to the Government's consultation on this.

GP pressures

You can't fail to have seen the negative - and undeserved - statements about GPs and general practice in the press and on social media over the last few weeks. This is infuriating, frustrating and hugely demoralising when you and your teams are working harder than ever, and trying to do the best for your patients.

Current frustrations over access are leading to GPs and patients being played off against each other by politicians, the media and Twitter trolls, which is never helpful, but is particularly damaging in the current climate. Patients can be our biggest allies and we need to work together to hammer home the message that general practice needs to be properly resourced - and urgently - if we are to deliver the standards of care that we want to give and that our patients deserve.

Please be assured that the College is not sitting back and taking this criticism. It’s the responsibility of NHS England (and its counterparts in the devolved nations) and Governments to introduce policies that ensure we have sufficient time to care for our patients and we are continuing our efforts to hold them to account. We will keep up the pressure in all four nations until we achieve sustainable, long-term solutions to the workload crisis which is affecting each and every one of us.

On the heels of last week's workload data, we've had the latest workforce stats, which show the number of full-time equivalent GPs is up 565 since the Government made its pledge of 6,000 more GPs. This figure includes registrars, and while we’re hugely grateful for the work our trainees do, they are in training primarily to learn. When you only account for fully-qualified GPs, there are 111 more than in March 2020 - but 223 fewer than when the 6,000 GPs were promised. Either way, nowhere near 6,000.

This is the problem in a nutshell: workload is soaring, but our fully qualified workforce is falling. And while trainee numbers look quite healthy, the unanswered question is how to retain trained, experienced GPs in the profession for longer. This must start with addressing 'undoable' workload.

Pregnant women - vaccine

It was great news to hear a few weeks ago that it is safe for pregnant women to be vaccinated, but the recommendation is that they receive alternatives to the AstraZeneca (AZ) vaccine. However, there is no way for them to book directly into a non-AZ clinic through the National Booking System - the advice is for them to call their GP. This is putting GPs and our teams - and pregnant women - in a difficult position. While we want to support our patients to make an informed decision about vaccination and we can try to help book patients into the right clinic if we can, it’s unclear what practices can do, particularly those not involved in the vaccination programme and in areas that aren’t expecting Pfizer or Moderna deliveries.

I spoke to BBC Radio 4’s Today Programme (2hrs 34mins in) this morning on the issue, calling for the National Booking System to be updated to allow eligible patients to book directly into a non-AZ clinic - and for clearer communications for practices. We want to help our patients, but with workload currently sky high, spending time navigating a complex booking system is not a good use of our time. Patients would also have a more streamlined, less frustrating experience if they could do it directly. With the announcement today that all under 40s will also be offered non-AZ vaccines, this needs to be addressed urgently.

Mental health

Recent ONS figures show a rise in the number of patients diagnosed with depression during the second lockdown - with 21% of adults experiencing depression between January and March 2021. This is unsurprising, as we continue to be at the forefront of caring for a new influx of patients whose mental health has been directly or indirectly affected by the pandemic.

It’s just one example of the increasing complexity of work we’re facing, on top of other growing workload pressures. Our calls to government and policy makers featured in The Guardian and we want urgent plans to address these intense workload pressures, so we can spend more time with patients addressing their more complex health concerns. Read our statement in full.

Also, thank you to Karen Forshaw, Chair of South Yorkshire North Trent Faculty, for the interview she did on Radio 4's PM programme on Wednesday, emphasising that GPs have been working hard to care for patients suffering with mental health conditions throughout the pandemic.

eLearning maintenance this weekend

Our eLearning platform is a fantastic resource for busy GPs, and perhaps never more so than over the past year.

However, please be aware that it will be out of action from today until Monday 10 May while we carry out essential maintenance and upgrade. Our online learning resources will be offline during this time and not available to users, although you can still book and attend any live webinars and online conferences or events.

Thanks for your patience.

Spring General Meeting

The Spring General Meeting will take place on Friday 14 May 2021. To register for the meeting, which will be via Zoom, please email and include your name and either your GMC number or RCGP Membership number.

Find out more (252 KB PDF).

How to diagnose and manage headaches in 10 minutes

This webinar, brought to you by the Tamar Faculty, will focus on diagnosing and managing headaches within the constraints of a 10-minute consultation. It will be recorded and available to delegates for six months post event. You can register now.

Post written by

Professor Martin Marshall, Chair of RCGP Council

Professor Martin Marshall is Chair of the Royal College of General Practitioners and a GP in Newham, East London. He is also Professor of Healthcare Improvement at UCL in the Department of Primary Care and Population Health. Previously he was Programme Director for Population Health and Primary Care at UCLPartners (2014-2019), Director of Research & Development at the Health Foundation (2007-2012), Deputy Chief Medical Officer for England and Director General in the Department of Health (2006-2007), Professor of General Practice at the University of Manchester (2000-2006) and a Harkness Fellow in Healthcare Policy. 

He is a Fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012. He has advised governments in Singapore, Egypt, Canada and New Zealand, has over 230 publications in the field of quality improvement and health service redesign and his primary academic interest is in maximising the impact of research on practice. In 2005 he was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. 

A co-founder and driving force of the Rethinking Medicine movement, Martin has a passionate commitment to the values of the NHS, patient care and ensuring the GP voice is central in a time of great change. When he’s not working, he likes being outside, preferably on a mountain or a coastal path with his wife Sue and their puppy. 

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