Doctors have warned that England’s primary care system is in danger of being overwhelmed in the aftermath of three lockdowns, with surgeries facing a huge backlog of demand from sick people who avoided using health services during these periods. The shift to digital consultations has also placed greater strain on services, GPs say.
Confronted with these pressures, many primary care networks (PCNs) made the decision in March to opt out of phase two of the national vaccination programme, which aims to immunise all adults under 50, with mass centres and pharmacies taking on the main burden of this responsibility.
“For many groups of GP practices the decision to opt out was driven by the release of pent-up demand from patients who had been holding off seeking GP care,” said Dr Michelle Drage, CEO of Londonwide Local Medical Committees, which represents almost 1,100 practices across the capital.
GPs have administered the bulk of vaccines to England’s first nine priority groups and will continue to provide second doses to those individuals still waiting to receive them.
But with this stage of England’s vaccination programme approaching an end, understaffed and overworked GPs have now begun turning their attention back to primary care and their ill patients.
In London, Dr Drage explained, this decision was also influenced by the acknowledgement that the capital has an overrepresentation of younger, more mobile people who are easily able to travel to mass vaccination centres.
“Having used their close geographical proximity and unique relationship with local communities to vaccinate the older and more clinically vulnerable patients, many London practices felt they needed to focus their capacity on burgeoning demand for essential GP services,” she added.
Dr Ollie Hart, the clinical director of Heeley Plus PCN, in Sheffield, said his network hadn’t signed up to phase two of the national programme due to the need to focus efforts on restoring primary care services.
“We’re very proud of what we’ve done and moved very quickly to vaccinate 16,000 of our highest at-risk people, twice,” he said. “It’s taken a lot of commitment and resources, and it’s a huge volume of work.
“We feel that volume of work needs to be redirected back to our main purpose in caring for our patients, especially amid the rising demand.
“It should be much simpler to organise and deliver vaccines to the younger, more mobile groups, and it now feels right to pass on that responsibility.”
Overall, more than 75 per cent of vaccinations administered in England to date have been delivered in primary care, according to the Royal College of GPs (RCGP).
However, Dr Kirsty Baldwin, a GP in Leeds, said “lots” of practices were “stepping back” from the vaccine programme as they were “no longer able to sustain the loss of the staff time in the face of unprecedented demand”.
A source involved in co-ordinating London’s PCNs told The Independent that there is still tension in the different networks, between GPs, who want to carry on providing vaccinations for younger patients, and senior officials who, on behalf of each PCN, have chosen to opt out of phase two.
The Royal College of General Practitioners (RCGP) said that “as far as we are aware, the majority of GPs are keen to continue their involvement in the Covid vaccination programme, but GPs know their patients best and they will make those decisions in the best interests of their local populations.”
There are also concerns about how under-resourced practices will juggle their growing patient backlogs alongside this year’s flu vaccine programme, which begins in September, especially after the NHS decided in January to include healthy 50-64 year olds among those eligible for a jab.
Dr Simon Hodes, a GP in Watford, said: “There are concerns about where the resourcing and staffing will come from to deliver this in general practice without disrupting routine care, and without adequate funding.” He said an autumn booster programme for Covid would further add to GPs’ workload.
Nonetheless, many health leaders and GPs are fearful that, even with renewed focus on primary care services, it won’t be enough to bring back the sector from breaking point.
“There just aren’t enough hours in the day,” said Dr Ayan Panja, a GP in St Albans. “I’ve no idea how we are going to catch up on the backlog and each time a GP retires or leaves it leaves the rest of us carrying more of the burden.
“We need a recovery plan and strong reliable leadership. The recovery plan would mean manageable workload, sustainable income and a happy workforce. It’s not easy.”
NHS figures show that practices in England delivered almost 5 million more appointments in March 2021 than the previous month, and nearly 3 million more than in March 2019. In total, 28.4 million appointments were booked in March – one of the highest figures on record.
Despite government efforts to address rising patient demand through increased recruitment, the number of full-time GPs in England has fallen by nearly 2,000 in recent years to just under 27,000.
Primary care deals with around 90 per cent of patient contacts for under 10 per cent of the national NHS budget. GPs also provide more than 300 million patient consultations each year, compared to 23 million carried out by emergency departments.
“Public attention on NHS pressures always seems to focus on hospitals, but we must not ignore the pressures in general practice as this will have dire consequences for the wider NHS and the care of our patients,” said Professor Martin Marshall, chair of the RCGP. “General practices keep the rest of the NHS standing.”
Dr Drage has meanwhile called for “an immediate end to over-promising to patients by national leaders, and an honest conversation about what the service can safely deliver with finite resources in the face of a still very live pandemic and the increased ill health that will follow it.”
She added: “General practice, with its capacity already overloaded before the pandemic, is on its knees.”