Why it's so hard to get a GP appointment

And why the answer is key to fixing the NHS

I’ve been puzzled for a while by an apparent contradiction. On one hand NHS data shows the number of GP appointments has risen considerably in the past few years: increasing from 26 million appointments in July 2022 to over 31 million appointments in July 2024.

At the same time you don’t have to sit long in a focus group (or a family dinner) before someone will complain about their inability to get an appointment. And this isn’t just anecdotal. The annual survey of GP patients shows fewer people saying they’ve had a consultation in the past three months than pre-pandemic. The percentage who say they had difficulty getting through to a practice by phone increased from 20% in 2012 to 50% in 2023. Overall satisfaction with GP services has collapsed from a peak of 80% in 2009 to 35% last year. 

Other measures that would indicate a real increase in appointments, such as a rise in prescriptions, have not materialised. Perhaps most importantly the number of referrals from GPs to hospitals has not gone up since Covid, which is a big surprise. - both because analysts assumed there would be a backlog of cases delayed from the pandemic period, and because we have an aging population with increasingly complex mixes of chronic conditions. Had the expected rise happened waiting lists would have been well over 10 million, rather than merely 7.5 million.

What we are seeing is an increase in unnecessary trips to A&E due to an inability to get a GP appointment, and a rise in emergency admissions for acute conditions that would have been avoidable had the patient been seen earlier. For instance, emergency admissions for hypertension have increased 165% since 2019. This is putting more pressure on already overfull hospital wards and waiting lists for elective surgery.

Understanding the reasons behind this contradiction is critical to fixing the NHS. As Lord Darzi’s recent report for the government set out, the NHS’s strategy for a long time has been to reduce the amount of care being done in hospitals by increasing the role of GPs and community care. But in practice the opposite has happened, with spending on hospitals rising from 47% of the total budget in 2006 to 58% in 2021. This is despite outcomes for hospitals deteriorating, with much higher waiting lists and many more people experiencing lengthy waits in A&E.

Wes Streeting has indicated he wants to follow the same strategy of pushing activity away from hospitals, to take the pressure off them, but why would it work this time if it hasn’t worked before? This is the key question his “ten year plan” will have to answer. And that requires explaining why, despite a big increase in activity by GPs surgeries, patients are experiencing a worse service.