With ever-increasing pressures on GP practices across the country and with winter all but upon us, Frome Medical Practice is asking patients to help ensure those with the greatest need can be seen over the coming months.

The partners at the practice say they recognise the current challenges with accessing appointments with a GP and other clinicians and acknowledge this is getting increasingly difficult.

The competition to get an appointment early in the morning is a problem for many patients and the practice says its staff understand the difficulty this is creating for the community but hope that an explanation of the pressures might help patients understand the situation being faced. 

The situation nationally 

GPs and their teams are working under intense workload and workforce pressures. Across England, the number of fully qualified, full-time equivalent GPs fell from 29,364 in September 2015 to 27,515 in August 2022, a drop of 1849. 

Professor Martin Marshall, Chair of the Royal College of GPs (RCGP), said: "GPs are leaving the workforce at all stages in their career, with many citing exhaustion and burnout as their reasons for leaving. Indeed, a recent RCGP survey suggested almost a quarter of GPs across the UK were so stressed that they felt they couldn't cope most days or every day. This isn't just impacting GPs but their patients too, with over 68% of GPs expressing concerns they don't have enough time to properly assess their patients." 

How the national issues are reflected locally 

The team at Frome Medical Practice is not immune from the loss of GPs and other health care practitioners and the strain that teams working within primary care are under. Dr Helen Kingston is the Senior Partner at the practice and is increasingly concerned about the demand for appointments, as well as for the welfare of the team working at the practice. 

She says: "We are working hard to strike a delicate balance between ensuring we make as many appointments available each day and ensuring we are not putting our staff at risk. We know the local community is increasingly frustrated about accessing appointments. But we want to give some context about the kind of pressure the team are under and dispel some of the myths that are circulating, such as the lack of appointment availability and face to face appointments." 

"Our GPs and clinicians are consulting with an average of 40-50 patients per day. Some of this work does take place over the telephone, which makes us much more efficient and suits many patients. But this can make waiting rooms appear empty and assumptions are then made that we aren't seeing patients. Please bear in mind when you see an empty waiting room this is because the consulting rooms are being used for patient phone calls or other clinical activity, such as writing our referrals to secondary care, interpreting test results and so on. And we have become much more efficient about managing patient flow within the building when we are seeing people face to face, so there is less waiting around for patients." 

"We are facing losses within the profession, and at the same time we are seeing an increased demand for services. There are many complex reasons for this, including a growing population, a rising number of elderly and frail patients and longer waits to access secondary care which means primary care continues to look after these patients. We are also faced with an increased amount of work transferred from hospitals to general practice, a growing list of new medications and treatments which require monitoring and managing and an increased need for mental health support. This all means it's increasingly difficult to get through to the practice for routine appointments in the morning and we are aware this causes frustration." 

"We are doing our very best under difficult circumstances to provide a good service and we also really need your help. Please be kind, polite and patient when contacting the practice, as we have seen increasing verbal abuse to our staff and this makes it even harder and more demoralising for our teams when helping you with your requests."

"If you are struggling to access care then, as well as giving us feedback, we would encourage you to write to your MP or the Secretary of State for Health explaining the strain primary care is under and how difficult it is for primary care to increase capacity when faced with a reduced workforce. The NHS needs to support our GPs, nurses, and allied health professionals rather than putting extra pressure on the system at a time of great fragility." 

What is the practice doing to try and improve the current situation? 

"We are implementing a number of schemes that we hope will make a difference to the current situation we are faced with: 

• We are delivering an increasing number of group consultations for specific conditions, such as diabetes, menopause and lifestyle medicine courses. 
• We are working on changes to the telephone system, which we hope will help with the waits people face.
• We are using a wide range of recruitment avenues and incentives to try and encourage applications for our GP vacancies.
• We have increased our focus on staff wellbeing, to help manage stress amongst the team and also help retain staff.
• We are in discussions with our Patient Participation Group about how we manage the current situation.
• We are working with the Somerset Integrated Care Board to share some 'day in the life' stories about the range of work that goes on in primary care to help increase patient understanding of the work we do. 

How can our patients help? 

"The following are ways in which patients can help support the practice: 

• Please remain patient when trying to access our services and be polite and kind to our team when you are speaking with them.
• Follow us on social media for useful information on new services, self care advice and urgent messages about staff capacity at the practice. Find us on Facebook and Instagram. 
• Likewise, check our website for any urgent messages about service delivery and use the website for checking information on particular illnesses or long term conditions.
• If you are housebound you can access advice from our complex care and home visits team. Choose this option when you make your call to the practice.
• Ensure you are doing what you can to look after your health. We call this self care. You can find out more about this on our website here.
• Before phoning the practice, check our 'common illnesses' section on our website. This covers a range of illnesses we often get calls about which can, in general, be managed at home and very rarely need input from our team.
• Before phoning the practice check if your problem is something that a local pharmacist can treat.
• If you are concerned about the health of your child, check the HANDI Paediatric App for expert advice on support on common childhood illnesses.
• Another good guide to looking after children with common illnesses can be found here.
• If you are eligible for a flu and / or COVID vaccine please ensure you have it. (COVID vaccines are booked through the National Booking System. Information about who can have a flu vaccine and making an appointment is available on our website.)
• Ensure your children are up to date with any vaccinations.
• Ensure you are up to date with checks such as cervical screening.
• Use the Cost of Living Support leaflet that has been jointly produced by ourselves and Frome Town Council and will be delivered to all households in Frome.
• Register to use our online services, which means you can book appointments for things such as cervical screening, blood tests and GP appointments (limited online availability) online, saving a call to the practice.

Dr Kingston added, "We are grateful that the majority of our patients are kind and understanding. We have a great team here at the practice who are working hard to support each other and our patients. We continue to treat 40-50 patients per clinician on average each day and we don't want anyone who is concerned about a health issue to feel that they cannot get in touch with us. We will speak with you and see you face to face when necessary to help you if you are unwell."

"We have said it many times over the last couple of years, but we are very thankful for your continued support and patience."