NHS: More doctors and online booking

GP David Turner no longer sees patients on Wednesday mornings.

Instead, he spends that time reviewing online appointment requests to figure out what each patient needs. Last week there were 84 requests, and the week before there were more than 100.

“It's relentless—you have about two minutes to look at each person,” says Dr. Turner. “We're getting a lot of inquiries that we wouldn't have had before—questions like, 'Should I take this dietary supplement?' Previously, patients would not bother GPs with such things.

“Obviously the concern is that there is something serious hidden there – I know a practice who only realized at 6.20pm that there was a patient who needed an urgent home visit. If they called on the phone, it would be recognized immediately.”

In September, Dr Turner's Hertfordshire practice began implementing a new government directive to offer online booking for non-urgent appointments across England.

The idea is to make it easier for patients to book non-urgent appointments or ask questions – and end the 08:00 scramble to get through on the phone, and in turn free up lines for urgent cases. But the increased administrative burden on doctors means practices are now offering fewer appointments overall.

“I'm not sure the government has thought this through very well,” says Dr Turner.

His trade union, the British Medical Association, is so concerned it has launched a formal dispute with the government over the new approach, warning that GPs will be overwhelmed and could put patients at risk.

This opens the door for the BMA to introduce operating rules that limit the number of patients GPs agree to see.

But how do patients feel? Members of the public told Your Voice and Your BBC News that while the online system was welcome, it was undermined by a long-standing problem of a lack of available entries.

Jo, 53, a former private hospital finance director who lives in Kent, tried to use the online system but there were no places available.

She sees her GP regularly because she is taking thyroid medication after having half of her larynx removed due to a benign tumour.

“My practice is to meet online booking requirements, but what's the point if you can't get an appointment?”

Joe's dissatisfaction goes beyond mere access, however.

“I know the staff are very busy, but sometimes their attitude is so dismissive and downright rude,” she says. “I recently had a blood test and the nurse was so harsh. They don't understand how scary it is when you worry about your health. If they did, they would be more compassionate.”

But Joe admits there are other aspects of the digital evolution of the NHS that are improving the quality of services. She can order repeat prescriptions online and, after taking blood tests, she has access to the results on the NHS app.

“It makes it a lot easier for people like me, but we have to remember that not everyone is digitally savvy,” says Joe. “My father doesn’t have a smartphone, so someone like him wouldn’t see any benefit in it.”

This is the same thing that feedback from Healthwatch England found.

For the past month, he has been tracking what patients report to local offices about the online scheduling system. The company says that while some report it has helped speed up the booking process, others fear being marginalized because they don't like the technology.

Rakesh, who lives in Southampton, had the same experience as Joe.

“I tried the online portal and you can book tickets six weeks in advance, but there are never any vacancies. Then you're stuck on the phone, hoping to get through.”

“You have a better chance of winning the lottery than going to a GP,” Rakesh says jokingly.

The 65-year-old says he is lucky because he remains fairly healthy and does not need to see his GP often.

“I feel sorry for people with health problems who need to see their GP regularly. The situation has definitely worsened in recent years. Since the pandemic, I have noticed a change: it has become much more difficult to visit a GP, especially in person.”

Rakesh, who used to be a merchant shipping captain and now works as a safety auditor in the industry, believes GPs should do more to improve access – or at least the GP partners who run the practice.

He points to the profits they make: GPs are effectively small businesses, with the latest available figures showing the average partner earning more than £150,000 a year.

“It is a very profitable business,” says Rakesh. “I don't think it's a question of money.”

His dissatisfaction is obvious and shared by many. Long-term British Social Attitudes research shows that satisfaction with GP services has reached its peak. lowest level since records began last year, less than a third of people were satisfied with the services.

Not everyone is unhappy though. Stephen's practice introduced online booking a year ago and has used it three times with great success.

“Each time I quickly receive a response message asking for a meeting or asking for additional information. One day I even got an appointment for the same day,” says the 67-year-old from Chelmsford. “It's a lot better than standing in a phone line.”

Stephen last used the online booking system due to pain and weakness in his arm. He was referred for physical therapy and was able to receive treatment from a local GP.

It is part of a nationwide program launched by the Conservative government that provides practices with extra funding to recruit physiotherapists, pharmacists and dieticians.

“It’s really convenient,” says Stephen. “I also had a pharmacist review my migraine medications and had my blood tested there. Previously, we had to go to a hospital or other place for this.”

Patricia, who is in her 70s and lives in Surrey, sympathizes with the pressure on GPs.

She, too, has difficulty booking an appointment through the online booking system, but says it is at least easy to use.

“The last time I tried to use it, there was nothing for several weeks, so you still have to rely on phone communication.”

Patricia has back problems and needed medication to cope with the pain. “It’s something that escalates from time to time. One day I had to call 999 and the paramedics arrived. But they couldn't issue a prescription—they had to call to get one. It all seems so ineffective,” she says.

“But I know the service is under enormous pressure. I think we need to rethink our approach.”

Patricia has a home in France and used a therapist there. “You pay a small fee per trip – and it's much faster and easier. This will encourage the public to use services more responsibly. You will need to pass some means test. But we pay to visit the dentist, why not a therapist? It's worth thinking about.”

The idea has been proposed many times over the past decade, including by former chancellor and health secretary Sir Sajid Javid. A number of European countries have some type of fee, as well as Australia and New Zealand. The argument being made is that this will raise vital funds and, as Patricia argues, encourage more responsible use.

But Experts from the King's Fund analytical center argue that the cost of implementing the system, coupled with the exceptions that would need to be introduced, would mean that “the pain is not worth the limited benefit.”

The government believes it has the necessary building blocks. Health Minister Stephen Kinnock says the steps being taken are working, noting that for the first time, more appointments are now being booked online than by telephone.

And after years of little growth in the number of GPs despite rising demand, he also says easing funding rules have seen the number of GPs increase by 2,500 in the last year or so (although some are part-time).

“We have the tools and resources to deliver modernized services that meet the demands of the future,” adds Mr Kinnock.

But this has not led – at least not yet – to a significant improvement in access. The most recent surveys are conducted by the Office for National Statistics, which conducts monthly surveys on access to NHS care.

People were last asked in late September and early October about their experiences over the previous four weeks – covering a period when the number of GPs had increased and when there was already significant access to online booking. Although offering online bookings only became mandatory on October 1, many practices took this step even before then.

Just over one in five respondents said they were unable to contact their GP on the day of their first attempt – similar to the situation the year before. Although there has been a slight decrease in the number of people who did not get through at all – a year ago it was almost 5%, and now it is just over 3%.

Professor Camila Hawthorne, from the Royal College of GPs, says it is clear there are still problems and she is not confident access will improve as much as the government believes.

She says some practices have struggled to implement online booking due to outdated IT systems, and while the rise in GP numbers is welcome, many thousands more are still needed.

“Evidence shows us that although patients demand appointments, they do not have the means to hire the GPs they need.”