A&E figures have made headline news, reportedly treating the smallest number of patients within four hours (68.6%), their lowest since the 95% target was set in 2004.
Due to delays in seeing and admitting patients through A&E, ambulance services are facing significant pressures. In the last year 21,663 patients were forced to wait for at least an hour with crews, the highest number ever recorded by the NHS. And once admitted, 2,347 people waited for 12 hours or more on a trolley.
As a GP working in a busy practice, I see the knock-on effects for patients facing potentially life-threatening delays in ambulances. They have to be monitored by doctors and nurses while they wait – this can be during a busy morning and can lead to long delays for others waiting to be seen.
A GP friend in the north-west of England had to drive patients to hospital after they had been waiting for four hours for an ambulance. She had worked a 13-hour shift and was starting early the following day.
Primary care is having to support more patients, many with multiple complex health conditions and frailty, who are waiting longer to see a specialist
Nationally, the GP workforce has shrunk by 3.7% since 2015, with a further drop in GP partner figures of 16%, at a time when the registered patient population is rising to 60.2 million. The number of patients at our practice has doubled to 23,000 since I joined in 2010. Across England, practices have seen an average increase of 28% as many close or merge, and there were 2.7m more appointments last year compared with the previous year. In parts of the country where GPs can see twice as many patients, millions now face waits of up to three weeks for an appointment.
The problem is not just that there are fewer family doctors. Primary care is having to support more patients, many with multiple complex health conditions and frailty, who are waiting longer to see a specialist. Last year thousands of people did not see a specialist within the NHS target of two weeks of an urgent cancer referral, and one in eight are waiting more than 18 weeks for a routine appointment. This leads to repeat GP appointments, requests for home visits, and increased paperwork trying to expedite referrals and arrange more tests.
We are also having to deal with the fallout from early or failed hospital discharges, where patients need to be followed up to discuss or arrange tests and initiate new medications – sometimes with scant information as we await discharge letters. It is not uncommon for a patient to need an appointment the day, or day after, they are discharged to manage an urgent issue that could not be dealt with while an inpatient. This inevitably means that many patients who are still sick end up being readmitted to hospital for an acute condition such as ongoing severe infection, breathlessness or dehydration.
'I'm being asked to take bloods while patients are on the floor'
Many of these revolving-door patients are frail and elderly or have got dementia, and are not receiving support in the community due to social care budgets being stripped to the bone. In a health system that depends on all services linking together, it is perhaps not surprising that we are seeing the NHS crumbling.
But we mustn’t accept this failing system as the new norm. Instead, we need realistic funding for health and social care with a clear focus on employing more staff and improving their wellbeing and morale so that they do not leave the NHS disillusioned and burnt out.
•Zara Aziz is a GP partner in inner-city Bristol