Written evidence submitted by Dr Claire Kendrick (FGP0094)


Barriers to accessing primary care

Main issue is simply not enough appointments due to there being not enough GPs / allied HCP.

We have struggled with this for several years and in fact introduced a dr first telephone triage system in 2018 to try and manage demand. Prior to introducing this system we had waiting lists of up to 3-4 weeks to be seen. These would include patients waiting with possible cancer and also this with trivial self limiting complaints – totally un-triaged .

By using telephone appointments we are able to squeeze in an increased number of patient contacts.

Since this system was introduced we are at least now able to triage and progress to telephone consultation (a skilful clinical encounter, not “just a phone call”) or to a face to face ( F2F) appointment if felt necessary by dr or patient. We can book a f2f appt ahead to another day if this helps with continuity (or often patient’s timetable)

Not infrequently patients decline offers of F2F appointments. 

This triaging is done by NEEDS ( “yes I will see you immediately with your acute shortness of breath / breast lump / rectal bleeding “ etc) not necessarily by WANTS ( “No I will not see you at 5pm on Friday with an ingrowing toenail /rash / vague tiredness symptom that has been present for 6 months because you are going on holiday tomorrow…”) – because there is not enough resource to go round.

The main issue for patients accessing our service is that by 10.00 all our same day telephone appointments  have been used and we can only offer urgent / emergency appointments.

I can imagine that this is frustrating for patients.

If we offer more advance appointments there are less to give on the day, so this makes the availability worse.

Our neighbouring practice did a survey of what types of appointments patients wanted locally in light of the pandemic and 90% wished to continue with a telephone triage system.

What would help?

  1. Better reception navigation skills (divert issues appropriately to admin or other HCP)
  2. More other healthcare professionals ( HCP) to share the appointments – the model of the specialist generalist accessing appropriate team.

first contact physio - we had a really successful pilot locally = all felt it worked very well > went to the CCG to procurement and they tried to do it ion the cheap and all of our physios left and got work elsewhere….

Pharmacists - a really useful addition within practice team – we have 2 and very helpful

care co-ordinators - we have an amazing care co-ordinator who can help sort out some of our vulnerable patients negotiate their social care needs that can take up a lot of dr time

mental health workers - our PCN Has been charged with trying to get some but has been unable to recruit.. there was only going to be money for a couple to share between the whole PCN – really to be helpful we could do with at least one full time just for our practice .

children’s mental health practitioners wouldn’t this be amazing. there is an explosion of child mental health problems at present!! There are NO primary care services available. In theory the school nurses help but in reality never seems to work. Children who are really unwell don’t always even manage to get to school..

social prescribers – great in theory and occasionally in practice but patients don’t always accept that they can help and sometimes feel fobbed off by a non clinician..

memory assessments in the practice – so many patients with memory problems deteriorate because they don’t see the need for a secondary care memory clinic referral.. a clinical nurse specialist in primary care would be amazing.


it would be really helpful to stop the quota driven mentality and let us work out what we need / what works locally. Eg our local PCN has been unable to recruit the exact roles specified but had some great ideas about who they could recruit that don’t meet the criteria.. just let us get on with it??


we are a training practice and also training physician’s associates.

So far they are very pleasant etc but create more worth than they release. Perhaps this will improve as they mature.


We measured our telephone demand over the last 6 months and it has approximately doubled! ( 1500 > 3000 =calls per week)



  1. More doctors and nurses!!!

These are the core workforce of GP. If we had more the model above would actually work well and access wouldn’t be such an issue.

In essence the GP is often the quickest and most efficient person to see.

Compare numbers of patients per GP in scandanavia ( Norway?) to england – approx. 2x as many patients per GP in England.

This also ties into reducing burnout / improving morale and increasing long term sustainability.

We recently did a survey when 3 of our drs left with workload related issues - currently in our practice the drs are working approx. 13 hours per week in addition to their standard 10 hour days. i.e. someone working “3 days per week” would in fact be working 43 hours.

( this is before you take into account extra vaccination shifts and extra shifts to cover colleagues who are ill or self isolating eg with covid )

This is clearly not sustainable and burnout is a real issue

To do this we need to train more drs . someone has clearly messed up the numbers.. bear in mind that because workload has slowly crept up, many retiring GPs are probably doing the work of 2 people (in their own time and with good will and NHS commitment) and will need to be replaced by more than one ..

We need to also attract new drs to be GPs many are put off by relentless long hours and unmanageable workload – but we are a training practice and have managed to recruit from GP trainees.  Looking forward we need to acknowledge that many of them cant envisage “just “ doing the GP shifts as they are so demanding. Most are looking for a “portfolio career with some sessions as a secondary care “GPWSI” ( GP with special interest) or a quality improvement role within CCG  PCN.

We need to make the GP job realistically possible to do in the time allowed – this is key – this will need a LOT more drs , longer appointment times ( at least 15minutes to sort out a complex multimorbid frail forgetful patient etc.) and dedicated times for doing the admin that results from direct patent contact ( not at 9pm when we crawl home after a 13 hour day…)

Public perception / expectation - Press and politicians  need to stop blaming the problems of the NHS on GPs!! We need an honest debate about what we can afford as a country and what this looks like. Its way too easy to scapegoat GP teams ( eg receptionists) for the wider problem of difficult access and mismatch of demand vs resource but do so at your peril because many of us have been working hard for many years due to passion and commitment to the NHS . we have squeezed out every last drop to manage the increased demands of the pandemic and if this is how we are thanked I think we will simply walk away.


  1. Online access ? – although in theory this sounds  great and we were initially interested, we have not fully embraced this because if we do it will directly result in less available appointments ( telephone and F2F)  . this is because we would need more dr time available to resource the online triaging service.  If we had this fundamental problem solved ( mre dr time) then in theory this could help as long as the IT worked and consults went into the patient record ( we did try a clunky system in the past where we had to keep cutting and pasting that worked poorly)

I feel that it is not fair to raise patient expectation regards this if we cant realistically provide it. Bear in mind the pyramid of need – if you make online access too easy the patients will lower their threshold for making contact. This could have a massive impact in increasing demand at a time when we cannot meet current needs adequately.


5 interface with secondary care.

Not sure how the figures work out but the proportion of spending in primary care compared to secondary care is ludicrously low…

at present the log- jam of work backing up in secondary care is also having a direct impact on primary care workload and management. Eg my patient waiting how bowel operation who has been admitted acutely 6 x in the last 5 months due to complications  - as well as not good for him , each episode involves extra work ; child I referred t mental health services in July received a letter in October informing them that they have been triaged and can expect to wait a further 12 weeks – has come to see me several times in the interim for help / support…

not to mention letters from hospital “can you arrange this / that blood test etc”


6 interface with social care

Massive impact – too big a problem to go into..



Named GPs.

In our practice we believe passionately in continuity of care.

It is more satisfying for the patient and the dr.

There’s a whole stack of data showing that it improves outcomes (reduced referral rates / investigation rates /prescribing rates and even a recent study from Norway showing significant reduction in mortality!

This has to be balanced with GPs not being in the surgery every day. This can be largely achievable if the system allows – e/g/ in our practice we allocate all patients to a “usual GP” we advertise which days drs are in on website etc. if it’s an emergency and usual dr is not in then they are seen by someone else ( Often in an emergency it doesn’t matter so much as the needs are pretty direct) otherwise I could triage a call and allocate a f2f or follow up appt for the patient with their usual GP on another day. So it can work with the triage system.

Our practice is a partnership but we also allocate “usual dr” to our salaried GPs. This is a bit of a hassle when they leave etc but it is possible


PCN role

in theory the PCN could be super helpful. Our was fantastic at getting the covid vaccination programme up and running.

Potential for additional roles somewhat stifled by lack of recruitment and lack of flexibility and some being too thinly spread.

Yet another layer of bureaucracy…

e.g. Why do I  have to tick a box every time I refer to our social prescriber?

(And why should we be penalised because we can’t currently refer to our social prescriber as she has left post?)



I don’t know the answers but it is full of targets that don’t always seem relevant to need.

I think smears and vaccinations can lend themselves to being counted but many other things are less  tangible and measuring does end up creating more work. 

Eg QOF / LES / DES / PCN targets.

I appreciate the requirement for some accountability..

Could the whole thing be simplified?

The local CCG seemed to work well – why did you have to make them much bigger and less accountable??


Dec 2021