Primary care

Access to care, and in particular inequality in access to care, remains a key concern. Before the pandemic, we heard from inspectors and external stakeholders how some people continued to face difficulties registering with a GP. This included people experiencing homelessness, as well as people with substance misuse or mental health issues. We also know that people who are registered with a GP can sometimes experience difficulties in accessing routine appointments. This included challenges in getting through by phone to make appointments and having to wait several weeks to be seen.

We have since seen a huge transformation in the way primary care services are delivered. GP practices were quick to rise to the challenge and rapidly adopt remote consultations by phone and video to continue to support the needs of their communities. NHS 111 online has seen a huge surge in use during the pandemic, as more people have used digital channels to access medical help or health advice – more than 30 million users visited the online service from the end of February to mid-August. Dental care providers have had very difficult challenges to overcome in reorienting their services to maintain levels of care.

While the work to bring about these changes must be applauded, there are important considerations about how to make best use of them to benefit all patients. For example, relying on telephone and online appointments raises concerns over GPs potentially missing diagnoses or not referring patients in a timely way. We are also concerned that people may not have been seeking help when they needed it because they did not have access to online or telephone care, were worried about catching COVID-19, or did not want to bother their GP at the time of a pandemic. Feedback from the public to Healthwatch England shows that without alternative options for those who need them, the shift to digital and telephone care risks leaving many people behind.

The substantial drop in the number of new referrals to treatment and the rise in the length of time patients were waiting for a diagnostic test show that there is huge pent-up demand for care that needs to be addressed. Not being able to access a GP and delays in referrals or diagnostic tests could potentially lead to a deterioration in people’s conditions. This is particularly important for people with time-sensitive conditions, such as cancer.

Primary care services need to make sure that people and patients are given the confidence to interact with them early, provide a range of different ways for people to access the care they need, and make it easy for them to do so.

As NHS 111 providers prepare for winter and a resurgence of COVID-19, they have told us they are learning from the last six months and have already started putting in measures to ensure they continue to meet demand and deliver safe and effective care. For example, they are continuing to recruit new staff and support them with the appropriate training. Also, providers are starting to build flexibility into their business models to account for uncertainty, including new working arrangements for staff. This is needed more now as the government looks to introduce the new NHS 111 First model, where people calling into NHS 111 can be offered a booked time slot into an emergency department.

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