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GPs forced to turn away patients because of winter pressures

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k81 (Published 05 January 2018) Cite this as: BMJ 2018;360:k81
  1. Gareth Iacobucci
  1. The BMJ

GPs are being forced to turn away patients because they do not have the capacity to safely treat the number of people seeking care this winter, doctors have warned.

General practice leaders said that the pressures reported in NHS hospitals are equally prevalent in GP surgeries, which are struggling to cope with an “overwhelming” demand for appointments and home visits, and a spike in respiratory illnesses and flu.

Dean Eggitt, a GP in Doncaster and medical secretary of Doncaster Local Medical Committee, told The BMJ, “I have never worked so hard and seen so many patients in my entire life. We’re getting to the point where we’re having to turn away patients because we can’t physically fit in any more people, it’s unsafe to do so.

“The demand is far outstripping capacity. Our emergency department is full, our walk-in centres are full, and everybody is struggling to meet demand. Patients are being bounced backwards and forwards. It’s palpably harder to deliver care.”

Data from the Royal College of Emergency Medicine show that in the final week of December, 75% of patients attending emergency departments in the UK were seen within the four hour target time, down from 82% the previous week. GP consultations for influenza-like illness in England also increased over the same period to 21 per 100 000 population, up from 18.9 in the week to 24 December.

Eggitt said that his practice was struggling to cope amid an increase in flu-like illnesses, and a severe spike in gastroenteritis-like illnesses that needed medical attention.

“It is difficult to deal with those acute illnesses on top of managing chronic illnesses with the same resources,” he said. “What’s upsetting is that this has been foreseeable for years. The long term solution is investment in staff.”

Richard Vautrey, chairman of the BMA’s General Practitioners Committee, said, “Practices are receiving overwhelming requests for appointments and home visits, and are struggling to cope.”

Vautrey said that GPs were fearful that the rise in flu cases would have a notable impact on patients in the coming weeks. “It could have a serious impact on the system as a whole,” he warned.

Zishan Syed, a GP in Maidstone and member of Kent Local Medical Committee, said that his practice had seen a rise in respiratory illnesses including flu, and now had a waiting list of “a good number of weeks” for routine appointments. The practice is also struggling to maintain access to urgent appointments and has seen “a huge increase” in requests for home visits, he said.

“GPs are working very long hours,” said Syed. “The main pressure is the increasing difficulty in admitting people to hospital. Also, when people are discharged from hospital, sometimes care packages are not being organised. In some cases we are being asked to do things like computed tomography scans which actually need to be done when people are in hospital.

“As a GP, I’m increasingly being asked to take on a lot of risk. I’m expected not to admit people because hospitals are too busy, but if anything goes wrong, one is expected to shoulder the blame. That can be a very stressful process for GPs.”

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