Nurses and other non-GP staff spending 42 minutes a week on access changes

Non-GP clinical staff including nurses and pharmacists are spending an average of 42 minutes a week implementing new online access changes, a survey has suggested.

Projected out to the entire non-GP clinical staff full-time equivalent (FTE) workforce in England (34,255), this equates to more than 145,000 10-minute appointment slots being lost each week.

The findings are based on a survey of 431 GPs and practice managers – encompassing 412 practices – carried out by our sister titles Pulse and Management in Practice.

GPs and practice managers were asked about the impact of the changes brought in on 1 October that require practices to ensure online requests can be submitted between 8am to 6.30pm.

Respondents suggested that the contractual change had forced some practices to cancel appointments to protect time to go through the requests, while some have had to extend staff hours.

The survey found the average GP is spending around 53 minutes per week on implementing the changes, while non-GP clinical staff spent 42 minutes on average and admin staff 31 minutes.

This was equivalent to 209,442 10-minute GP appointments and 145,333 non-GP clinical staff appointments.

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The BMA has formally entered a dispute with the Government over the changes, warning that many practices would struggle to implement the changes safely and would have to introduce waiting lists.

In all, 93% of survey respondents said their practice had implemented the changes – up from 60% before 1 October – with 47% seeing waiting times increase as a result. Just over a third (36%) said they were able to clear all late online requests on the day.

Common measures for dealing with the changes reported by GPs included blocking appointments to create space for triaging (58%) and extending staff hours (43%).

And 77% of GPs said their practice would continue to close for half-day training, with only 4% reporting they had stopped them because of the contract changes.

A GP in Cambridgeshire said the changes have made their practice ‘feel even more like a production line’.

They said: ‘The GP day, which was previously already “full on” – grabbing lunch, difficult to find time even to eat, debrief registrars or go to the toilet – has now become even more relentless.

‘How sad to feel even more like a production line. Quality general practice needs time to pause, evaluate, reflect, contact patients about abnormal results, check in on cancer or palliative patients.

‘With all inputs on, all of the time in the day, the quality of care in other areas will reduce as we can’t fight fires and plan holistic medical care for vulnerable patients simultaneously.’

Many GPs reported significant cutbacks in the number of available appointments and GP sessions due to implementation requirements.

Surrey GP partner Dr Dave Triska said his practice has seen an approximate 15% increase in online submissions since 1 October, despite his practice continuing to turn off the tool in the middle of the day to protect time for receptionists to phone patients.

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Dr Triska said the increase in expectations of immediate access is like ‘trying to fit a pint into a thimble’ given the realities of GP practice capacity to deal with requests.

He said: ‘The current mitigation in a system that is sensible is that you absolutely have a human review for this, a clinician review, ideally, because at least then you can do that with the voice of experience rapidly.

‘But the operational problem is that you physically can’t do that in practice, from 8am until 6.30pm in the evening without significant denigration of services, or indeed the person providing that service.’

Another GP said: ‘We previously had phone lines off between 12.30 and 2pm (emergency line open) to allow reception staff to crack on with referrals and prescriptions.

‘Having them turned on has been terrible and staff are burning out already as (there is) no time to do the admin work. We are a small surgery with limited space.’

A Department of Health and Social Care spokesperson said: ‘This data only represents a very small percentage of GP practices. Patients want this service, with more people now contacting their GP online than by phone, and we gave practices six month notice to prepare for the rollout.

‘We are grateful to the majority of practices are already delivering this service successfully – to the benefit of patients and their care – and we are supporting others to increase compliance.

‘To support GPs, we have also provided an extra £1.1 billion of vital funding and have recruited 2,500 more GPs.’

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When the changes were first introduced, practice nurses said they had been asked to work longer hours to help meet the extra demand likely to be triggered by the move.

Our sister title Pulse  recently reported that GPs were warning the new requirements risk compromising patient safety, with patients reporting breathing difficulties, severe vomiting, acute abdominal and chest pain, and rectal bleeding through online forms.

A version of this article was first published by our sister title Pulse