/ Health

Will changes to GPs be the cure to your medical irritations?

Female blowing nose on the phone

An end to 10-minute doctor appointments, registering with a surgery of your choice and booking appointments online – what do the changes to the GP and health sector in England mean for you and your family?

A new contract for GPs in Englandwas announced earlier this month, with changes due to come into force in 2014-2015. These moves are pitched as offering a return to a more personalised service from your GP. There are a number of changes due to come in and I’m keen to hear how you’ll respond to the developments.

For example, the requirement for GPs to no longer have to offer 10-minute appointments is being scrapped. This works for me personally as it usually only takes five minutes or so for me to present my dodgy sinuses to the doctor.

But this is perhaps not so good when I think about the Which? mystery shopping of GPs last year, when we sent trained undercover fieldworkers into 30 GP practices across the country to assess the consultations given to patients. Consultation times varied between three minutes to 20 minutes for the same patients with the same symptoms. And we found a link between the length of consultation and the rating, with all 12 ‘poor’ consultations lasting eight minutes or less and all but two of the 14 ‘good’ visits lasting 10 minutes or more.

Registering with a surgery of your choice

How about the plans to make it easier for me to register with a surgery of my choice outside traditional practice boundaries? Sounds good if I can visit a doctor near to where I work in Central London. But what will the effect be on my local practice if patients like me jump ship?

At least I’ll be able to book my appointments online, another agreement in the GP contract. That means no more dialling and re-dialling as soon as the surgery opens. This development sounds like bliss to me as long as there’s an appointment left for me to book. And the increased access to telephone consultations sounds good for avoiding having to sit in a crowded waiting room.

Named and accountable GP for elderly patients

My parents will like the idea of having a named and accountable GP (they’re both over 75 so this applies to them, and my dad has serious health problems). Although it will be good to understand what this will mean in practice – surely they won’t be able to ring their named GP at all hours of the day and night? And will their GP really have time to form personal relationships with all those patients?

There have been other commitments outside of the GP contract update too, including  offering  longer opening hours too , with seven day a week services being piloted. What’s not to like about the flexibility of being able to see my GP on a Sunday – although I wonder how the resourcing is going to work.

But there’s one commitment that really appeals: all GP practices will publish GP net earnings from 2015 – something we’ll be keeping an eye on just as we would any other industry or sector.

So what do you think of the proposed changes -are you happy to book an appointment online to save time or will you miss the personal touch? Would you like to have a named and accountable GP no matter what your age is?


I am cautiously optimistic about the proposed changes. One of the reasons I chose my present GP surgery was they seemed to be better organised than the others in the area. It offers telephone consultations and Saturday appointments, though I have not chosen to use either. I do book GP appointments online, choosing either an appointment with my own GP or sometimes with another member of the practice if I want to be seen more promptly. The appointments are notionally for ten minutes but longer consultations are offset by shorter ones, so there is rarely a significant waiting time.

The opportunity to choose a GP outside existing boundaries is interesting. Joanna makes a good point about the convenience of visiting a GP near her work, but what will happen if people start to do this just because a GP or their practice has a good reputation?

I don’t think the convenience of seeing a GP near your place of work is a good point at all. If you need to see a GP, what are you doing at work?

Since I’m stopped work, I haven’t been to a doctor for over 3 years now.

Having a doctor near work would have cut down the amount of stress and grief you’d get for needing time off just to see one. Although you could always stay extra late to make up the time, regardless of how many extra hours you’d already put in that week.

And being able to book online would certainly make it easier ( no that line is busy please try again for almost 30 mins ) and no huge phone bills cos they were using expensive lines.

Rachel says:
27 November 2013

I welcome the change particularly I have changed my GP twice in the past four years due to dissatisfied service. I wish I could register with the one near work. She is popular and experienced. The author said those GPs outside the city will be left out. I’m not worried at all. I think the new system will eliminate those who are not good enough to be in the system. One good visit is much more important than two mediocre visits which ended with some painkillers.

Online booking is a must nowadays. I will never register with a GP practice which only takes phone calls at 8:30am (does it only help those who don’t work?)

Pauline Rhead says:
28 November 2013

I like the extended opening as getting in to see a doctor at my practise is my main bugbear. I also like the idea of booking on-line. Registering with a practice of your choice would depend if they had a full patient list. I have a surgery 5 minutes down the road but they don’t take new patients. Luckily the practice I am with ( about 15 minutes away) is very good apart from trying to book an appointment in advance. Urgent appointments on the day of ringing I have always found available buy booking a non urgent appointment almost impossible.

Having used the online booking system through EMIS access for several years I did not know it is not already universal.

Whilst using a surgery near to work may be useful occasionally I should have thought that near to home when home-confined (infectious etc.) would be more convenient. If one could change at will from one to another it seems to be a nightmare for administration when my experience is that I am currently awaiting the fifth version of a hospital referral appointment (the last one was the third attempt). Local practices do not promise to be more efficient.

My local practice already has fixed doctor for 50+ with other doctors available if non-core matters and the admirable nurse practice for bloods etc.

Availability must be on a need basis and not a 24/7 all services. Perhaps an extension of the duty practice system where possible would satisfy.

Payments to GP practices is not indicative of individual doctors’ incomes and varies enormously depending on services provided. A full breakdown would be difficult to maintain and publish and not helpful for most people. It would simply be another ‘them’ bashing statistic for the intellectually challenged politically correct.

Andrew says:
29 November 2013

I strongly agree with your many good points.
For years my EMIS practice has had electronic booking of appointments, not to mention automatic electronic transfer of test results and prescriptions.
And why all the excitement about “a named and accountable GP” for the elderly? Wasn’t that the system we had for everyone, young and old, since the dawn of the NHS until it was removed a few years ago in yet another “reorganisation”?
Politicians seem to love the revolving doors of reorganisation. Once they have stopped something they can proudly announce its reintroduction as an improvement in the service! And announcing as new something that at least some have had for years is both disingenuous and annoying.

Rosie says:
28 November 2013

We have online appts but little availability and none within 2 wks. Good re surgeries outside area as can be quicker to get to than supposedly local one. Good re GP pay but why net not gross and net of what? 10 min appts should stay. GPs should have to do callouts locally, not ever changing temp drs. GP pay needs reviewing. They shouldn’t be able to get equivalent of full time pay for part time hrs. Difference between working hrs and conditions between GPs and doctors in hospitals appears very unfair on hospital drs. Our GPs now seem to have very cushy jobs for too high pay!

That seems a bit harsh. Doctors earn very good money, yes, but on the other hand a doctor can save your life, a banker can’t. Personally I think medics, firemen, policemen, and the military are underpaid. When your house catches fire, you’re hit by a car, you’re mugged, or your country gets invaded, you don’t send for Beckham or Rooney.

Did you know that an average working day for a GP is 11-12 hours and that many do more from home using remote access? I would not call that a cushy option.

Dennis King says:
28 November 2013

Generally I feel that I get good service from my G.P.`s. I also feel that if they expect to recieve large salaries that they should be prepared to work some kind of 24/7 -364 system and be examined on their professional competence anually … like professional pilots.

All doctors undergo an appraisal every year where they demonstrate their ability to remain up to date.

Janis says:
28 November 2013

Speaking from the point of view of someone who used to work in a surgery I fail to see the improvement in treatment if, when you are at your sickest, when you need a home visit, if you have chosen a surgery miles from where you live, you will not be visited by any Doctor from your registered surgery. You will see “your” Doctor only when you are well enough to go to see him/her

Sadly not all employers like staff taking time off even for doctors visits, and the stress that builds up because you do is crippling. And at your sickest you still can self certificate, which leads to more stress…. And even when you end up needing counselling, you’re just grateful that they work non GP hours.

Suzanne says:
29 November 2013

Beware! If you are able to go out of area for your GP, the other side of the coin is that they will not be required to take you on because you are in their area, as happens now. If you are an unattractive prospect, i.e. someone on very expensive medication, or with complex needs, or ‘difficult’ (euphemism for mentally ill or learning disabled etc.), you might find your local GP, no longer obliged to take you on, refusing to accept you or even asking you to find another practice. This is a very real possibility, and it is not clear whether or how such patients would be able to appeal such a decision.

The ability to make appointments on line is, as others say, excellent. I would add to this that it would be good for preliminary or back-up consultations to be possible by email (even if via a web box for security reasons).

I know many people would prefer old fashioned methods, but a large enough proportion would use the Internet with the result that there would be less pressure on staff manning the telephone and the waiting room/surgery.

Queue the messages not the people.

I welcome any change to the existing disasterous GP contract which was predominantly weighted in the GP’s favour not the patient. Having an opportunity to choose a GP outside of a restricted home area is a godsend. For a start I shall change to one that gives me online access to my health records, allows on line appointment bookings and does NOT use 0844 numbers.

Helen says:
29 November 2013

Joys of joys. This is an answer to prayer.Having been with a doctor whose time limit for patients is 3 minutes at most (I time them as I wait, shortest time is 1 minute !!) I can’t wait to change.Its the only way I and my family can register our protest at years of poor uncaring service as the nearest good doctor was out of area. I just hope it applies here in N.Ireland?

Ever wondered why it might be so difficult to get an appointment? General practice funding has fallen (in contrast to what you might read) and demand and workload have gone up ( often due to work of dubious effectiveness being forced into our contract by the current and previous governments) The result is that despite working flat out we still can’t meet the demand and no-one is happy! Offering email, phone and Skype consultations does not increase availability of GPs as we can still only be doing one at a time.
There is a concerted campaign in some areas of the media to paint GPs as fat cats with cushy jobs, and from one or two postings here it seems to be working! But the reality is that per consultation or patient contact this part of the NHS is very efficient and cheap. Recent figures showed that primary care receives 8.4% of the total spend of the NHS and carries out 90% of the patient contacts. For a tiny increase in share to say 10%, which would represent a huge 19% increase in primary care funding, the problem of capacity could by wiped out at a stroke. The extra capacity would also ease pressure in other areas of the NHS and pay for itself many times over.
To do so though, the government and press would have to get over their obsession with GP pay ( a misnomer- we take home what’s left over after paying rents, bills, salaries and for all those things that get consumed in seeing patients (no, they don’t just get supplied to us!)). Trust me, we do want to provide a better service and GPs are so demoralised and stressed that we would be desperate to spend any increase in funding on more GPs, nurses and administrative staff!

I can understand most of that, but email phone and Skype consultations do remove some of the stress from patients (which results is patients that are less sick) and does also stop patients being contaminated with each other’s diseases in a waiting room. Both these negatives cost the NHS money to rectify.

Many patients are also people in work and who want to be away from work for as little time as possible. On line consultation (where appropriate) makes the consultation process as efficient as it can be. I wonder what the total hours would be if you added up all the person-hours people spend in waiting rooms, for all fee earning professionals throughout the country.

Having people sitting around in waiting rooms may be a great boost for the professionals’ egos, but is hardly efficient from any standpoint.

Queue the messages not the people.

I don’t have a problem with phone, email or Skype consultations per se (provided they are for problems that can be dealt with remotely), just the belief in some quarters that they will somehow increase capacity which they won’t.
Re waiting times, this is sometimes the price of having a decent consultation with your GP. We’re constantly trying to fit a gallon into a pint pot and that means either you get a short time with the GP and don’t feel listened to, or you’re allowed enough time, made to feel more relaxed and the surgery will over-run (for everybody).
The 10 minute consultation is another misconception – the appointments are at 10 minute intervals – that means reading the patient’s notes before they come in and making your own notes at the end all have to take place in the 10 minute slot as well as the face-to face consultation. Throw in taking an urgent call from someone (police, social worker, psychiatrist, A&E, hospital doctors), arranging an admission for a patient or an emergency within the practice and there’s no wonder we over-run as there’s no slack in the system at all.
Finally, what do I gain from routinely running late? I have a life outside of work too. A full waiting room definitely does not boost our egos, it creates stress and fatigue.

We need more capacity.

Heather says:
29 November 2013

Funny I should come across this item this week as I had an appointment at 9am one day this week I have various things I needed to discuss nothing really major but could have been dealt with in the allocated time. I informed the GP of this and was told that I could only deal with one problem at one appointment. e.g. I need to change my pain relief and also dizziness which was very quickly diagnosed and medication sorted no way the 10 mins. but he would not let me deal with anything else I cannot believe that I have to make 4 more appointments, so why have they stopped telephone appts at my surgery, not happy at all with the way things are going at the moment

That is appalling.

If it is officially sanctioned, does the government suffer from schizophrenia? On the one hand it wants us to avoid congestion (encouraged by congestion charges), conserve fuel and reduce carbon emission (fuel taxes), and look after our health (prescription charges).

On the other, it has five traffic movements when one is sufficient, and run five times the risk of cross infection in the waiting room. (And there is a finite risk in every traffic movement.) It costs money to resolve these potential health issues.

I don’t know how long the wait is in this particular patient’s surgery, but assuming an average 20 minute waiting time beyond the appointed time, then the GP has taken over an hour of her life in just waiting for the four needless extra appointments. In order to be on time, patients are advised to get to appointments early to allow for traffic jams etc. Therefore if this patient gets there ten minutes early each time then this is another total of 40 minutes wasted on these extra appointments.

If the patient is in work, then this policy wastes all this in terms of working hours. Add this up all over the country for every surgery and hospital (and other centres where people have appointments, like government officies and courts of law) that work like this and the number of working hours lost must be similar to those lost by strikes or as a result of drunken behaviour and other ills.

Our GP surgery ignores the one problem per appointment rule. I think they know full well that if I go in with one problem I’ll want to take advantage of the appointment to ask about something trivial that’s probably not worth a separate visit. It’s just human nature.

My GP surgery does not limit the number of problems per appointment, though patients are asked to book a double appointment if necessary. I turn up five or ten minutes before the appointment time and usually don’t have to wait very long. Tomorrow morning I have a medication review with a GP and an asthma check with a nurse. I won’t know which appointment will be first until it has happened because the admin staff just fit patients in, to make best use of the time available. If I had thought there was a need to change my medication I would have waited for an appointment with my usual GP.

As an 80 year old man with an 85 year old partner, both with multiple NHS problems, the idea of having one GP for us is very appealing, assuming we can choose who we get. I also like Online booking of appointments, though my wife is not computer-friendly and would not appreciate it. Our current system of having to try to get through at 800 in the morning is a nightmare. The other major irritation I currently have is that each visit is supposed to cover “one medical issue”. In our situation we invariably have several things of concern. I therefore always ignore this injunction but always feel a bit guilty about it. As for phone appointments this is ok for minor things, but, despite the disadvantages I generally prefer to be face to face. Finally all of this is going to take much more GP time. Where is it going to come from??

Jill Kershaw says:
1 December 2013

As a GP Appraiser, I would like to make a few comments about general practice. In the course of my work, I find that most GPs in my area work over 12 hour days and hope to eat a sandwich for lunch while hunched over their computer or while driving to do home visits. The number of doctors off sick with stress or burnout is increasing. Their take-home pay is meanwhile dropping. It is hardly surprising therefore that the number of newly qualified doctors wishing to work in this specialty is dropping. How, then, is general practice going to cope with increasing appointment times (something which all GPs would like in an ideal world) and increased “opening hours”? All patients would like to see their own doctor at all times of day and night when they are ill, but there have to be compromises and we can only have what we pay for.

I don’t think increasing GP’s pay is going to combat stress, but cutting down working hours and working in a well managed practice might help. My own GP works two days a week and shows no sign of being stressed. One GP works four days a week and one day by rota, but the others work three or two days a week.

I do not doubt that there are stressed GPs working long hours – but the same applies to many jobs, and we urgently need to recognise and deal with occupational stress before it becomes a problem.

One way of saving GPs time would be to encourage patients to get a neighbour to take them to the surgery if possible, thus cutting down the number of home visits.

If someone is sick enough to require a doctor, going out and possibly spreading a contagious disease to neighbours, and others in a waiting room doesn’t seem a brilliant solution.

How about a district nurse type of healthcare worker who is sufficiently qualified to resolve many problems and if necessary report back to the doctor? Such people could become known to individual patients and be as good or even better psychological support than a hurried doctor. No individual should be on 24hrs call out, but a group of three could all become known to individual patients. In addition (s)he could have limited powers of prescription and could even collect required medicines for house bound patients.

Do we really want people with diseases such as flu going out on the bus to see doctors or collect prescriptions? Not encouraging such mingling would surely be good preventative medicine that would pay dividends.

My local GPs surgery has an excellent website that explains how the practice works and the options available to patients. That was one of the reasons why I registered with the practice when I was told that the surgery I was registered at would probably be closing in the next year.

The last time I saw my GP, she was happy to discuss a couple of extra issues and we achieved this within the ten minute slot allotted. On the practice’s website is a request that anyone with a complex problem or need to talk to their GP should mention this when booking an appointment, so that a longer consultation can be accommodated without keeping others waiting.

Earlier in the year, the receptionist was able to fit in an appointment with the GP and one with a nurse on the same morning. I am overdue an asthma check with the nurse, and hope to have this done when I visit my GP for a medication review. If this is not possible, I will ask if it is possible to do the medication review by phone.

I would like to thank those who are part of the medical profession for commenting here. So often the consumer complaint is that the service provider won’t communicate. This has got to the point that many manufactured goods don’t even have a maker’s name and contact details affixed to it.

Which’s purpose is to get consumers the goods or service they actually want and are paying for. It is very clear that this isn’t being achieved by health services, but what needs to be discussed is how it could be achieved.

The NHS is particularly difficult because there isn’t a well defined link between “want” and “paying for”. The funding is collected from people in general by force, and the service is delivered as of need in an authoritarian way and limited by necessity. As it is delivered inefficiently (ie what we have been writing about, queues etc) it actually costs more to deliver than if it was delivered in an ideal way.

Google “Chronosphere Achieving truly universal health care” for a long term solution, but in view of the comments made from GPs it seems the only solution right now is shorter hours and many more GPs. This can’t achieve people having the access to the same doctor day and night, but if there are three doctors with whom the patient is familiar and who are all familiar with the patient one should always be available.

From the point of view of paying for all this, it would seem that the basic rate of income tax needs to rise. I am sure that it doesn’t need to rise to the excesses of the 1970s to get a good result. Maybe if someone in the know can offer a figure as to how much more funding would be needed for the required improvements, it would be possible to calculate what the rise needs to be. 1p on basic rate raises 1.45 billion pounds. Taxing minorities who have few votes may win elections (it even got Hitler elected) but it is very difficult to raise sums anything like this by these means.

I cannot see that 20 minute appointments are nothing more than political rhetoric.Where are the resources coming from?
How my local practice operates is a mystery. We , the patients, have no information on the number of ‘doctors’ hours’ available each week and we do not know how many patients are seen. The only statistic published is the number of missed appointments by patients:we are never told how many doctors’ hours are lost.
We also do not know the number of days doctors work beyond their allotted hours as this too is a known unknown.It just seems that when demand builds up then appointment dates get pushed out into the future, and this will probably be the result of 20 minute consultations if introduced.
My last consultation was a joke, the GP said after having heard me describe my symptoms, ‘ what do you think the problem is’ and when I said I had no idea and added ‘I am not a doctor’ he said ‘Oh you are not a doctor’.
I know there are many hardworking and dedicated doctors in the NHS, there are also some who could do better.

Can I start by saying that, good or bad, these changes leave me in a position of never again believing a word David Cameron says, so he can stop promising me my pension is safe with him?… 😀

It seems that in some respects my local surgery is ahead of the game. We’ve always had a named GP who is overall responsible for our wellbeing, but this does not, as you query in the intro, mean that you can automatically get to see them whenever you like. They do have lives of their own.

They also play fast and loose with the appointment times. They do allocate sessions in 10 minute intervals, but once you’re in there they’ll stretch things if necessary, and if, like me quite often, you can be dealt with in 5 minutes, they don’t keep you hanging on for another 5 just to make up the time.

We can also make appointments online and indeed check in via a touch screen in the waiting area if there’s a bit of a queue for the receptionist, and we can also opt for a telephone consultation. So far so good…

I’m not in favour of being able to register with a GP outside my area. If I’m sick enough to go and see a doctor then I should be inside my area already. Any GP or A&E will deal with emergencies, but if I’m ill enough to see a doctor then I’m too ill to go to work or on holiday.

24 hour opening 52 weeks in the year would be lovely, and also completely impractical, but weekends and longer hours I’m all in favour of. The only thing is, this makes it even less likely that you’ll be able to contact your named GP.

Personally I’d like to see an NHS that is run by the profession with no more mismanaging by here today: gone tomorrow MPs.