There are a number of underlying factors which result in a demand for appointment significantly outstripping what we are able to offer.

A significant growth in our practice population

In 2010 the Humbleyard Practice, which comprises of Cringleford, Hethersett and Mulbarton surgeries had a registered patient population of 14,000. Large housing developments in our practice area has led to the registered patient population increasing, as of January 2023, to 22,000. This increase of 8000 patients over the last 13 years had led to us being the 4th largest practice in Norfolk (total of 104 practices) and the 228th largest in England (total of 6375 practices). There are 43 GP practices in Norfolk which have a registered population of 8000 or less, illustrating that we have essentially had to absorb a patient list comparable to the total patient list size of many other surgeries in Norfolk.

Unfortunately prior to developments being approved there is very little consultation with primary care services to ensure they can meet the demand of the increasing population.

With ongoing local housing developments we are anticipating another 3000 patients being added to our practice population in the next 3-5 years.

The pictures below show some of the recent housing developments.

More complex patients

With an ageing population, longer life expectancy and increasingly sophisticated medical treatments, patients who present to primary care are much more complex. We look after a number of care homes and have had assisted living developments open within our practice area. Our clinical systems allow us to analyse our patient mix and it is clear that the proportion of complex patients in our registered population is rising. Patients who fall into this category will need input from the GP services more frequently, sometimes necessitating multiple appointments per week. This is imperative to ensure safe care is provided. We can only provide a finite number of appointments per week and therefore this puts a squeeze on how many appointments are left to offer.

It is likely that the proportion of complex patients will increase further in the next 3-5 years.

Not enough GPs

Currently there are about 27,300 full time equivalent (FTE) GPs in England. In 2015 this was around 29,000. The NHS has lost the equivalent of  2,059 full-time fully qualified GPs since 2015 at a time when more GPs are required.

This is national problem and it is well publicised that the GP workforce hasn’t increased to meet the demand of the population. Unfortunately due to the stress of the job many GPs are changing their roles or retiring early. It is very difficult to recruit new GPs and this shortage means we can struggle to provide an optimal level of appointments. It also means each GP takes responsibility for more patients which unfortunately can exacerbate workload stress and burnout.

If you want to read more about this trend and look at more data please look at the following link:

https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis

Long hospital waiting lists

Due to a number of factors, including COVID-19, the waiting list for hospital appointments and operations has lengthened significantly. The Norfolk and Norwich Hospital do publish their waiting lists and you can find this information here.

The wait for the vast majority of specialties is between 6 and 18 months.

Whilst patients await specialist care, they continue to have symptoms and often these deteriorate whilst they wait. This results in patients consulting with their GP more frequently during the wait period. We also receive daily requests to try and expedite appointments. If the waiting lists were reduced more patients would have their needs addressed by the hospital services resulting in less pressure on primary care. Unfortunately it may take many years for this situation to improve.

What are we doing to try and meet the demand

Expanding our workforce

Although recruiting GPs is difficult, we have been fortunate enough to welcome a number of other fantastic, highly skilled individuals into our team. This includes advanced nurse practitioners, physicians associates, emergency care practitioners, outreach nurses, physiotherapists, pharmacists, mental health worker and social prescribers. This skill mix provides a number of pathways which can be offered to patients when they contact the paractice.

Care navigation

With a finite number of appointments available, is it imperative that each appointment is used appropriately. We have highly trained care navigators who work in our appointments hub. When a patient contacts the practice, one of our care navigation team will ask some appropriate questions to understand the underlying concern. The team member will then consider which of the many various options available would best suit the scenario. If we are at capacity then the care navigator will be able to advise you on the options available. The team are supported by the GPs in the practice.

Use of online services

We are using our online consultation tool PATCHS to provide easier access to the GP surgery appointments and services. This service is provided by an external healthcare company and functionality will be added over the coming months.

Proposed new surgery

We are actively looking at options to expand the GP surgery buildings. We often run out of available rooms in the practice and new premises will allow us to provide more clinical services on a daily basis. Please note we are in the early stages of this process with the NHS Estates team.

Working with our Patient Participation Group (PPG)

We have active PPGs and have regular dialogue with the PPG members to outline the pressures on the system and listen to patient feedback on how the services could be improved.

The current contact with NHS England means that we are unable to turn patients away if they request to register with us. This means that even though we are oversubscribed in terms of patient numbers we have to continue registering patients.

PATCHS is our online consultation tool. It allows you to contact us for a routine health problem via an online form rather than having to wait on the phone. It is much more sophisticated than e-mail and gives us lots of tools to help manage requests. There are numerous different online communication tools being made available to primary care and we have chosen to use PATCHS as our option as we feel at present it best suits our needs. Please bear in mind that we don’t design PATCHS or control the interface, but it does plug into our clinical systems to ensure your messages come through to us.

You can use PATCHS to:

• Request a routine appointment for a medical problem (if your issue is urgent do not use PATCHS, phone us instead)
• Request a medication (one off or repeat)
• Request a sick note

Yes you can. However rather than selecting one of the “Health Problem” options, please select the “Other” option or if this is unavailable the “Admin” option (this will be more obvious when logged in to PATCHS). Please do not use these options if you are requesting an appointment for a medical problem. Using the “Other” or “Admin” option you can request an appointment for:

• A long term condition review – for example asthma or COPD check, blood pressure review or annual diabetes monitoring
• Routine monitoring blood test
• 6-8 week post natal baby check
• Cervical smear
• Family planning services such as mirena coils, implants or pill checks
• Routine vaccines / immunisations
• Travel vaccines

Requesting routine appointments via PATCHS means you can request an appointment without having to wait on the phone. This means we can try and keep the phone lines free for urgent issues which may need an on the day appointment.

Your form will be looked at by our care navigation team and with support from the doctors in the practice, you will be offered the most appropriate appointment option based on the information provided. This may be a face to face appointment, telephone call, online message reply with advice or signposting to a more appropriate service. Please note depending on the volume of forms we receive it may take up to 3 working days to process you form. If an appointment is needed we look to book this in within 6 weeks, but often it is well within this timeframe. We will communicate back to you regarding the appointment options, or if we need more information, via the PATCHS system (you will be notified via a text message and/or e-mail about any reply). Although going via this route means we may not be able to instantly provide you with an appointment date, you can be reassured that your request is logged and we will contact you with the options available. 

We want to talk to patients who are requesting an urgent appointment to gather as much information as possible and ensure we prioritise the most urgent cases. There are benefits to directly speaking to patients with urgent issues rather than going via an online system. In addition we receive a large number of PATCHS forms every day and it isn’t always possible to look at every form submitted that day. We wouldn’t want an urgent case to be missed therefore ask for any urgent appointment requests to be phoned through to the surgery.

There are times when due to clinical capacity we have to turn the forms off. This is to ensure we can safely manage demand as uncapped we would be receiving in the region of 200-300 forms / day (in addition to urgent phone calls) and we would be unable process this number in a responsive timeframe. There is a cap on the number of forms we can accept every day and if this is exceeded the forms will turn off. The forms will generally then be available again at the start of the next working day. We are looking to increase our online form capacity moving forward.

Please note the “Medication request” forms will always be available alongside the “Admin” request option. We are happy for you to use the “Admin” option to request a routine nurse appointment (as listed above in this document) but do not use this option for a routine medical problem.

If this is the case please phone us or visit the reception desk and one of our team can help you fill out a form or do it on your behalf. You can also allow someone (for example a carer) to register on PATCHS for you and submit a form on your behalf.

Visit our PATCHS page at https://patchs.ai/practice/thehumbleyardpractice

You can use a browser on any device to access PATCHS (phone, tablet, laptop or desktop)

From here you can create an account, or login if you already have one

The team from PATCHS have their own help document which provides more details on the service, you can find this at Patients – PATCHS Support

Although we could create our own help document, as PATCHS is frequently being updated with new functionality we feel it best to link to the support guides provided by the PATCHS team.

We do hear this feedback from time to time. The forms are structured in a way which help GP surgeries get as much relevant information as possible, in a format which is easy for us to process. This ensures we can make a decision on the most appropriate appointment option. Although the person submitting the form may prefer just to add information like they would in an e-mail, it really does help us using the PATCHS structured format. Please note we don’t have any direct control on how the forms appear.