Closed petition Create a legal right for patients to receive timely face-to-face GP appointments

There are reports of some GP practices refusing requests for face-to-face appointments from patients, despite guidance stating patient preference should be respected unless they are considered a covid-19 infection risk. Government should legislate if necessary to put this fundamental right in law.

More details

The pressures of the pandemic should not be used to introduce a major permanent change to GP services. Without the physical proximity to a doctor, some conditions may not be diagnosed through remote consultations alone. Older patients, in particular, may be uncomfortable with, or ill-equipped for, video or telephone consultations and be unable to describe their symptoms correctly. In a survey of Silver Voices members, over 70% reported difficulty this year in seeing a doctor.

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Government responded

This response was given on 2 November 2021

Government currently has no plans to legislate for face to face appointments, however practices should respect preferences for face-to- face care unless there are good clinical reasons to the contrary

Read the response in full

The Department currently has no plans to legislate for patients to receive timely face to face appointments. Patients should always be able to choose whether they see or speak a GP or member of their team, unless there are good clinical reasons to the contrary. Regardless of how people access GP services, they should receive the same high quality of care- in many cases, remote appointments provide extra flexibility and convenience for patients.

In response to the pandemic there have been big changes to the way general practice operates: by necessity, practice teams rapidly adapted their ways of working in order to keep practices open and vital services going. To manage demand and reduce the risk of infection for staff and patients from Covid-19, general practice teams innovated by providing more remote consultations and utilising triage. This ensured practices prioritised the most urgent care needs and could direct patients to the right service, with the right primary care professional at the right time. We owe them our profound thanks for their outstanding efforts through the most challenging period in living memory.

It is vital as we emerge from the pandemic, that we continue to support general practice teams to provide the best possible care to patients and ensure that patients are able to see their GP in the way they want, and receive the same high quality of care, no matter where they live. We know that general practice is very busy and demand for services is high. Appointment numbers have returned to pre-pandemic levels, and in August there were on average 1.14 million general practice appointments per working day, an increase of 2.2% compared to 1.12 million in August 2019 (pre pandemic). We also know that although remote consultations provide extra flexibility and convenience for patients to access services, they are not appropriate for all patients or in all circumstances.

That is why we have published a comprehensive new plan to support GPs, and to make it easier for patients to see or speak to GPs and their teams.

The measures in the plan will help GPs to increase face to face appointments, tackle variation in performance, reduce bureaucracy, and enhance the role of community pharmacists and other clinicians, so that patients everywhere can benefit from the high quality care that our GP practices offer.

The plan includes a £250million Winter Access Fund: a non-recurring revenue fund, ringfenced to protect and expand capacity in general practice for 6 more months until March 2022.

The plan also strengthens our commitment to boosting recruitment and retention, and freeing up capacity for general practice staff, through drawing on the talents of our community pharmacies and their teams.

It also shows how we’ll protect colleagues from the unacceptable abuse from a small minority, including by creating a fund for extra security measures.

Finally, we’re putting in place clearer expectations around appointments. Although the vast majority of GPs are doing brilliant work at a tough time for our health service, there are also a small number that aren’t performing in the way that the public expects. We’ll identify these practices, and intensify our support, for example by expanding the work of our Access Improvement Programme, which supports struggling practices.

The work below highlights additional ongoing work in the department and NHSE, to ensure better access in future for patients:

• The provision of additional funding of £270million from November 2020 until September 2021 to help expand GP capacity to ensure they provide quality care to patients in the challenging circumstances presented by the pandemic.

• Our commitment to support general practice to deliver an extra 50 million appointments a year by March 2024, and to expand the practice workforce so there is more capacity to deliver better care. The Additional Roles Reimbursement Scheme is open to all PCNs to reimburse 100% of employment costs of a range of primary care professionals, such as pharmacists and physiotherapists. We are training more GPs than ever before, with the highest number of doctors accepting a place on GP training in England in 2020 – 3,793 and we have committed to increasing the number of GP training places to 4,000 in 2021.

• NHSEI Access Improvement Programme is supporting practices whose patients are experiencing the greatest challenges in providing good access to patients. NHSEI is currently supporting over 900 practices to design and deliver tailored support packages for those practices.

• Evaluation and learning from rapid service change. NHSEI has an independent evaluation underway to understand the implications for staff, patients of using digital tools in primary care, including the effectiveness of online consultation systems that support triage in general practice. Findings from this evaluation will support improvements to the services practices provide.

Department of Health and Social Care

This is a revised response. The Petitions Committee requested a response which more directly addressed the request of the petition. You can find the original response towards the bottom of the petition page (https://petition.parliament.uk/petitions/587701)

Other parliamentary business

MPs to debate GP appointment availability

MPs will debate GP appointment availability on Tuesday 26 October in Westminster Hall. The debate will be led by Joy Morissey MP.

This will be a general debate. General debates allow MPs to debate important issues, however they do not end in a vote nor can they change the law.

The debate will start at 2.30pm and last for up to an hour and a half.

Watch the debate: https://www.parliamentlive.tv/Event/Index/a3334a61-a7ff-4701-b830-6da0a2edf636

You'll be able to read a transcript of the debate a few hours after it happens: https://hansard.parliament.uk/commons/2021-10-26

Find out more about how Parliamentary debates work:
https://www.parliament.uk/about/how/business/debates/

You can also sign up to the UK Parliament newsletter for the latest information on how to get involved and make a difference: https://learning.parliament.uk/en/your-uk-parliament-newsletter-sign-up-form/

Original Government response

Practices are expected to offer both remote and face to face appointments taking into account clinical appropriateness and patient preference for appointment type.

General practice teams have remained open and offering face to face appointments throughout the pandemic and we are incredibly grateful for their tireless and continuing efforts and all they have done to support their patients, including their vital role in delivering the national vaccination programme since December 2020.

General practice teams are busy, working hard to meet high and rising demand for services as restrictions ease. In June 2021 there were an estimated 31.1 million appointments in general practice, including Covid-19 vaccinations delivered by general practice. This is 30.1% more than June 2019 (23.8 million). There has been a strong recovery in appointment numbers from a low point in April 2020 at the start of the Covid-19 pandemic, where appointments per working day were 0.83 million rising to 1.22 million in June 2021 (excluding GP delivered Covid-19 vaccination appointments), over half of which were face to face (56.3%).

In response to the pandemic, general practice teams rapidly changed how they provide support and deliver services to their populations, with a focus on triage and remote (telephone, video and online) consultations. This enabled practices to see as many patients as possible, while minimising risk of infection from Covid-19. Remote consultations provided alongside face to face appointments, provides extra flexibility and convenience for patients to access general practice services.

NHSEI estimate that 95% of practices now have online consultation capability and 99% have video consultation capability, prior to the pandemic data from the General Practice Forward View (GPFV) Monitoring Survey estimated that 42% of practices had online consultation capabilities and 3% had video consultation capability.

We understand that some patients have concerns about accessing general practice services, including getting through on the telephone and with the availability of face to face appointments. NHSEI has throughout the pandemic provided guidance to general practice and on 19 July, following the Government’s announcement of a move to Step 4 of its Covid-19 response, NHSEI wrote to general practices, to outline the expectations across primary care in relation to access, infection prevention and control and continuing contractual/regulatory requirements. The letter reiterated that general practice contractors should continue to offer a blended approach of face-to-face and remote appointments, with digital triage where possible. We know that remote consultation, telemedicine and online access can provide flexibility for patients accessing services and that many people find online consultations more convenient and accessible.

To help expand general practice capacity and to ensure general practice can continue to provide the necessary care for all patients during this busy time, we have made available an additional £270 million funding from November 2020 until September 2021.

We are training more GPs than ever before, with the highest ever number of doctors accepting a place on GP training in England in 2020 – 3,793, against a target of 3,500, and a commitment to increase the number of training places to 4,000 in 2021. However, there is a finite number of GPs in the general practice workforce and that is why we increasing the number of other direct patient care staff in general practice by 26,000 to ensure that patients can access the right service, with the right member of the primary care team, which may or may not be a GP, at the right time.

NHSEI leads a programme of work to support practices use of digital and online tools to widen access to general practice services. The Department, NHSEI and NHSX maintain an open dialogue with GP representative professional bodies, Voluntary, Community and Social Enterprise organisations, and patient organisations to understand access issues and how to better support the safe and effective use for staff and patients of remote consultations in general practice. NHSEI have an independent evaluation underway to understand the impact for staff, patients and the wider health and care system of using digital tools in primary care, including the effectiveness of online consultation systems and triage in general practice. The NHSEI Access Improvement Programme is supporting practices whose patients are experiencing the greatest access challenges, such as drops in appointment provision, long waiting times, poor patient experience or difficulties in embedding new ways of working relating to Covid-19, such as remote consultations as part of total triage.

Department of Health and Social Care

This response was given on 30 July 2021. The Petitions Committee then requested a revised response, that more directly addressed the request of the petition.

Access to GP appointments to be debated by MPs

MPs will hold a debate on access to GP appointments on Wednesday 12 January in Westminster Hall. The debate will be led by Theresa Villiers MP.

The debate will start at 4pm and last for half an hour.

Watch the debate here on Wednesday: https://www.parliamentlive.tv/Event/Index/f2c6b0e0-72ed-4f28-bb3f-341dfeed924a

You'll be able to read a transcript of the debate a few hours after it happens: https://hansard.parliament.uk/commons/2022-01-12

This will be a general debate. General debates allow MPs to debate important issues, however they do not end in a vote nor can they change the law.

Find out more about how Parliamentary debates work: https://www.parliament.uk/about/how/business/debates/

Get involved in the work of the UK Parliament

You can sign up to the UK Parliament newsletter for the latest information on how to get involved and make a difference: https://learning.parliament.uk/en/your-uk-parliament-newsletter-sign-up-form/