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GPs face nearly 10% rise in patient contacts in two years

NHS finances squeezed as GP referrals go up by 3% in a year and emergency admissions by 4%

Louise Prime

Friday, 18 November 2016

GPs have dealt with an almost 10% jump in the number of patient contacts over the past two years, and over two-thirds of clinical commissioning groups have reported that their forecast position for this year relies on additional financial support, confirming the huge and growing pressures on general practice, the latest monitoring data reveal. This week’s report from The King’s Fund also found that several key NHS performance indicators are at their worst in over a decade – as the NHS as a whole is now treating more patients than ever before.

For the first time, the charity analysed demand and activity in general practice for its quarterly monitoring report (QMR), based on data from 202 practices (about 2.5% of all those in England). Its analysis revealed that the number of patient contacts with GPs has risen significantly over the past two years, with an overall 9.9% increase in quarters one and two of 2016/17 compared with the same period in 2014/15.

Telephone contacts accounted for a large part of this increase – they rose by 36.6% over the two-year period, compared with a 6.1% rise in face-to-face contacts. The King’s Fund said that a 4.6% increase in registered patient list size over this time accounts for some of the rise in overall number of contacts. The greatest number of patient contacts, as well as the greatest two-year rise (of 26%) in the number of contacts, occurred in the over-85 age group, with 75-84-year-olds close behind.

The QMR shows that increasing demand for services is reflected in the number of GP referrals, which increased by about 3% over the past year; and emergency admissions via A&E are 4% higher than in the same quarter last year, putting increasing pressure on NHS services that are struggling to maintain standards of care as a result. The charity pointed out that as referrals to secondary care are outstripping population growth, this not only increases pressure on secondary care – it also generates extra work for general practice.

In her blog for The King’s Fund, GP trainee Emily Northern commented: “GPs must be supported to manage the increasing level of demand and the subsequent pressures this causes. General practice has always been at the heart of the NHS; to ensure its future, the onus is on policy-makers, health care leaders, GPs and trainees to develop a model of general practice that will meet the needs of both patients and workforce.”

The QMR includes results from an online survey of clinical commissioning group (CCG) finance leads, covering 48 CCGs. Close to two-thirds (63%) of these forecast a surplus for 2016-17, and 10% are expecting to overspend; more than two-thirds (71%) said their forecast position for 2016-17 depends on significant financial support; and more than one in five (21%) are relying on having their 1% risk reserve released back to them. The King’s Fund said this situation “creates the risk that the position may worsen later in the year”.

The QMR also found:

  • 9.4% of people attending A&E waited more than four hours, which is the worst performance for this time of year for more than a decade.
  • 9.4% of patients waited longer than 18 weeks to begin hospital treatment, the worst performance since targets were revised in 2012.
  • July to September saw a record high of 568,774 bed-days lost as a result of delays in discharging patients from hospital; this is 29% higher than in the same quarter last year, which “underlines the impact on the NHS of cuts to social care budgets and other problems in co-ordinating care”.
  • Nearly a third of NHS trusts are forecasting that they will miss their ‘control totals’, up from 13% in the last quarter – yet 2016-17 is meant to be the year that the NHS stabilises its finances.

The King’s Fund’s chief executive Chris Ham said: “The NHS is treating more patients than ever before, and these findings show that rising demand is putting its services under increasing pressure. The NHS needs to redouble efforts to manage demand and this will require investment in out-of-hospital services via the sustainability and transformation plans now being developed across England.”

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