Transforming General Practice: Challenges, Optimism, and the Promise of Digital Healthcare

Channel 3 Consulting’s Dr. Manpreet Rakhra is a practising NHS GP. Here he gives us his unique view on what the GP Patient Survey (GPPS) is telling us.

It’s no secret that the National Health Service is under immense pressure. The findings of the GPPS, the independent annual review capturing the patient experience in general practice, reflect the tension in primary care.?

While patient care remains resilient, systemic issues persist, straining staff and services. Despite these challenges, there are significant reasons for optimism, rooted in technology-enabled advancements and transformation.

The 8am rush indicates a system under pressure

The data highlights the struggle between supply and demand in primary care.?

In July 2024 alone, a staggering 31.7 million appointments were delivered. That is a huge amount, considering that a shrinking workforce means practices face growing challenges in meeting patient demand.?

This tension between supply and demand is the root cause of the infamous "8 a.m. rush," with patients competing for limited appointments via overwhelmed phone lines. Only half the patients surveyed found it easy to get through to their practice by phone, a stark reminder of the bottlenecks in access.

The GP’s view:

“Doctor, I can’t get an appointment” and “I was number X in the queue”; are two of the most common frustrations heard amongst patients trying to tackle the ‘8am rush’.

This is in part due to the demographic that often seek a GP appointment not being familiar with other, more digital, ways of booking appointments, for example online or using mobile apps.

As patients remain cared for…

Despite these daunting figures, patients continue to be cared for. While patient satisfaction dipped in 2022, it has stabilised in recent years, with the majority of patients reporting their needs were met during appointments. The enduring dedication of healthcare professionals, even under mounting pressure underpins the resilience of the system.

…the workforce is feeling the strain

The Royal College of General Practitioners Tracking Survey (2023) reveals dissatisfaction, overwork, and declining mental health (reported by 54% of GPs).?

It’s not hyperbolic to say that we face a GP crisis, with 37% of GPs considering leaving the profession within five years.

Additionally, over 50% of GPs said they have insufficient time to build meaningful patient relationships. Morale within the profession has suffered a profound blow.

The GP’s view:

The pressure faced by patient-facing staff in primary care is unsustainable. As a GP, there is expectation to see a patient within 10 minutes which includes; reviewing the notes, taking a history and examining, requesting tests, prescribing medication, making referrals, all whilst ensuring documentation is robust. Technology has a huge role to play in reducing workload, relieving admin and ultimately improving patient care.

How to alleviate the strain?

The government’s approach to reforming the NHS focusses on three shifts from:

i)?????????????? Hospital to community (‘left shift’)

ii)????????????? Analogue to digital

iii)??????????? Sickness to prevention?

Bringing this vision to life has dependencies including; a cultural shift supported by the hard-working staff that make up the NHS, the digital infrastructure to support change and a strategy to empower the population to live healthy lives.?

The “Pharmacy First” approach, for instance, redirects patients with manageable conditions such as UTIs or sinusitis to community pharmacies, easing the load on GP practices and offering faster care. ?However, we need to ensure that pharmacies have the capacity to manage the increased demand in addition to their already stretched services.

GP practices (which includes not only GPs but nurses and Allied Health Professionals) and pharmacies also need the appropriate training and resources to successfully deliver the service, which is in part dependent on having a digitally mature infrastructure that supports the transfer of data.?

The GP’s view:

There is definitely an inconsistency in approach when it comes to GP practices referring patients to pharmacies and pharmacies managing these patients. For me this is evidenced by the fact that common ailments such as UTIs are appearing in my clinics when they could be managed elsewhere. I wonder how many people are aware that ‘Pharmacy First’ exists?

The NHS ‘Delivery Plan for Recovering Access to Primary Care’ is committed to

i) Empowering patients to better manage their own health by e.g. expanding self-referral pathways and expanding Pharmacy First as above

ii) Implementing ‘Modern General Practice Access’, ensuring all practices move to digital telephony and adopt other digital tools to improve efficiency (see below)

iii) Building capacity by making an extra ￡385m available to employ 26,000 more patient-facing staff, delivering 50m more appointments by March 2024.

iv) Cutting bureaucracy giving GPs more time to focus on the patient.?

Health promotion needs to start early and continue throughout a person’s life, preventing chronic conditions from developing in the first place and supporting those with illnesses to live happier and healthier for longer. Learning how people want to engage with health is important to designing an approach that will yield positive results. On average in the UK, people spend almost four hours per day on their smartphone and this very capable device is key to unlocking a new and engaging way of managing and monitoring health. ?

Video and virtual are not the panacea

One of the more striking insights from the GPPS data is the underutilisation of video and online consultations, which accounted for a mere 3.5% of appointments in August 2024.

Compare that to the 64% of consultations that were face-to-face and 25% by telephone. It is also worth noting that 43% of consultations were on the same day.

So, while the pandemic showcased the potential of virtual healthcare, barriers such as unreliable technology and scepticism among both patients and clinicians have limited its adoption thus far.

The first step to improving virtual consultations is to find out the common reasons for their underutilisation and then using this data to design viable solutions.

The GP’s view:

Having used video consultations in clinical practice, I have had mixed experiences, often reverting to traditional face-to-face consulting. The reasons for this include; a poor internet connection resulting in a blurred image and it taking too long to set up. Also, I have not felt it has supported my assessment enough to make a reliable treatment decision. There is definitely a role for virtual consultations, but the technology needs to be able to support a quick, clear and safe assessment.

There are alternatives

Increasing awareness of alternative channels for patients to access the care they need will help reduce the demand facing primary care. This can be through digital triage tools and signposting via services including telephony and the NHS App.

‘Modern General Practice Access’ is being achieved in part by supporting practices to transition from analogue phone lines to digital telephony, with ￡240m available to support this.?

The aim is to have all practices to move to digital telephony which will allow the handling of multiple calls and include call-back functions to prevent patients from being on-hold at 8.00am.

Future cause for optimism in the role of digital

At Channel 3 Consulting we are in a privileged situation, we see how digital and data can transform healthcare. We have three causes for optimism for the future, where digital will be key to improving the standard of care, quality of experience (of care and life) and the positive transformation of our health service.

1. Improved triage and signposting

Help patients to use alternative channels to access the care they need, to reduce demand on primary care. Better awareness, signposting and use of digital triage tools like the NHS app and digital telephony need to become the norm.

2. Investment in patient education and preventative care

By educating patients and equipping them with digital tools, we can help them self-manage of their own health conditions. Promoting and assisting healthier communities will not only reduce demand on primary care services but also help people live better lives.

3. Service readiness?

Organisations need to be ready to offer this education and support, identifying those who need help and signposting those who can help themselves. To improve services, there needs to be robust measurement of success and a culture of change.

Building for the Future

The GPPS data and NHS reforms collectively highlight a critical crossroads for primary care in England. Technology, while not a panacea, has the potential to address inefficiencies and reimagine how care is delivered. Equally important is addressing the well-being of healthcare staff, without whom no system can function effectively.

The confluence of robust investment in digital infrastructure, cultural shifts towards patient education, and innovative triage strategies gives us cause for optimism that the NHS can position itself for sustainable improvement.

The road ahead will not be easy, but the seeds of transformation are already being sown. In an era where demand for care shows no sign of waning, it is this adaptive spirit that offers a cause for optimism for patients and practitioners alike.

To find out how we at Channel 3 have supported health systems to reimagine primary care pathways, harness data to develop models promoting channel shift, enabled through whole-system cultural transformation – reach out to our Primary Care Transformation team:

Josh Hutchison – Partner, Channel 3 Consulting

Manpreet Rakhra – Senior Consultant, Channel 3 Consulting and GP

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