Access to GP appointments and services

Background

Primary care is the first point of contact for the majority of people seeking healthcare, and accounts for most of the activity that takes place in the NHS. Good access to general practice services is an important element of the quality of care and indicates a responsive and timely healthcare service. 

The coronavirus (Covid-19) pandemic caused considerable changes to how patients access GP services, and many practices rapidly adopted a ‘digital first’ service. This meant that all consultations, where possible, took place by phone or video. There was also a move towards ‘total triage’, where patients provided some information on their reasons for contacting the practice and were triaged before making an appointment. These changes have been absorbed into routine practice now, with services continuing to offer remote appointments and using a triage model. 

The GP Patient Survey gives patients the opportunity to provide feedback on their experiences of their GP practice and other local NHS services. This indicator uses data from the survey and data collected by the NHS on GP appointments to comment on access to GP services. 

GP Patient Survey respondents were asked, ‘Generally, how easy is it to get through to someone at your GP practice on the phone?’ Many patients have found it easy (‘very easy’ or ‘fairly easy’), however this proportion has fallen from 81% in 2012 to 50% in 2023. The proportion of patients who found it ‘not at all easy’ to get through to someone at their GP practice on the phone has increased almost fivefold from 5% to 24% over the same period. People who responded ‘haven’t tried’ have been excluded for comparison purposes. The growing difficulty in being able to contact GP practices is reflective of current challenges faced by primary care services, which include a declining workforce tasked with managing a larger number of patients with more complex conditions.

Since 2018, GP Patient Survey respondents have been asked ‘How easy is it to use your GP practice’s website to look for information or access services?’. Between 2018 and 2021, the proportion of patients who found it ‘very easy’ or ‘fairly easy’ decreased slightly from 78% to 75%. Since then, it has fallen more significantly to 65% in 2023. The proportion of patients who found it ‘not at all easy’, having remained constant at 7% for four years, increased to 11% in 2022 and 12% in 2023. The proportion who said it was ‘not very easy’ also increased from 15% in 2018 to 23% in 2023. People who responded ‘haven’t tried’ have been excluded for comparison purposes. Given that the NHS requires all GP practices to offer online services in a step towards the digitalization of primary care services, it is important that websites be easy to use. In light of this, the growing trend of people finding it hard to look for information on GP practice websites is worrying. 

In 2019, an average of 25.2 million appointments took place in general practice each month. Of these, 42% took place on the same day as booking (10.5 million appointments), 20% within two to seven days of booking (4.9 million appointments) and 14% within 8 to 14 days (3.5 million appointments).

At the start of the Covid-19 pandemic, the number of appointments in general practice fell by a third, from 24 million in March 2020 to 16 million in April 2020. However, the number of appointments taking place on the same day as booking remained roughly constant. The largest falls were for appointments taking place within 15 to 21 days of booking (a 77% fall, from 1.7 million to 404,500) and within 8 to 14 days (a 75% fall, from almost 3 million to 725,272).

Since then, the number of appointments has grown larger than the count prior to the pandemic. In 2023, between January and September, 28.5 million appointments took place on average each month. 

In September 2023, an average of 31 million appointments took place in general practice each month. Of these, 40% took place on the same day as booking (12.3 million appointments), 18% within two to seven days of booking (2.3 million appointments) and 13% within 8 to 14 days (4 million appointments). Compared with 2019, a larger number of GP appointments are taking place, but a lower proportion of those appointments are being offered within a week of booking. 

Enabling patients to see or speak to the GP they prefer is important for continuity of care, and evidence suggests that it can lead to more satisfied patients and clinicians, reduce costs and result in better health outcomes.

Until 2017, GP Patient Survey respondents who stated that they have a doctor they prefer to see at their surgery were asked, ‘How often do you see or speak to the GP you prefer?’ Between 2012 and 2017, the proportion of patients who ‘always or almost always’ saw or spoke to the GP they prefer decreased from 42% to 33%. Those that ‘never or almost never’ saw or spoke to the GP they prefer increased from 6% to 9% over the same period. This indicates that continuity of care in general practice may have worsened. Note that those who responded 'not tried at this GP surgery' were excluded for comparison purposes.

The 2018 GP Patient Survey altered the question slightly to, ‘How often do you see or speak to your preferred GP when you would like to?’ Between 2018 and 2023, the proportion of patients who ‘always or almost always’ saw or spoke to their preferred GP decreased from 26% to 16% and those that answered ‘never or almost never’ increased from 10% to 19%. Although these results are not directly comparable with surveys prior to 2018, they show a decline in continuity of care over time. See 'About this data' for further information.  

GP Patient Survey respondents were asked, ‘Overall, how would you describe your experience of making an appointment?’ 81% of individuals in the least deprived areas and 77% of individuals in the most deprived areas reported a ‘very good’ or ‘fairly good’ experience of making an appointment in 2011/12. While the percentage of individuals who reported a favourable experience declined over the next five years, the decrease was sharper for those living in the most deprived areas than for those living in the least deprived areas. In 2016/17, 76% of individuals living in the least deprived areas reported a favourable experience, compared with 69% of individuals living in the most deprived areas.

In 2017/18, the question about experience of making an appointment did not change, but several changes were made to previous questions in the survey. Testing revealed that respondents may have answered the question that forms the basis of this indicator differently, and so the data is not comparable with previous years. 

Between 2017/18 and 2019/20, the percentage of patients reporting a favourable experience fell proportionately for both groups. There was an uptick in experience in 2020/21 for both groups, with 74% of individuals in the least deprived areas and 67% of individuals in the most deprived areas reporting a ‘very good’ or ‘fairly good’ experience of making a GP appointment.

This difference in experience may stem from the difference in GP practices situated in the most and least deprived areas. GP practices in the most deprived areas tend to be more under-funded and under-doctored than practices in wealthier areas, causing individuals attending practices in deprived areas to have a less positive experience overall.