A GP surgery in Nottinghamshire has been forced to cap the number of same-day “urgent” appointments after it was left trying to cope with more than 100 patients per doctor – four times the safe daily limit – for several weeks.
It comes as more NHS trusts across the country declare critical incidents, and one of the country’s biggest hospitals opened a critical care surge ward in a move not seen since the height of the pandemic, as winter pressures ramp up.
The whole of Nottinghamshire has been in “critical incident” status for a week, with health centres across the county struggling to cope due to a “large number of very poorly people” being admitted to A&E with respiratory conditions.
GP surgeries are also dealing with a deluge of patients.
Staff at Torkard Hill Medical Centre, in Hucknall, have been dealing with an “unprecedented increase” in demand on all its services, including “exceptional demand” for urgent on the day appointments – defined as something that cannot safely wait for another day, cannot wait for a routine appointment, and requires a GP.
The centre apologised for capping urgent appointments but said it was left with no choice.
When Torkard Hill declares itself full, patients will need to contact NHS 111, visit a pharmacist, attend a walk-in centre, or in very urgent cases attend A&E, it said.
“Our current system of having limitless urgent on the day appointments has now become unsustainable and affects our ability to safely look after our patients,” the surgery added in a statement.
“Over the past few weeks, we have had the equivalent of one GP managing over 100+ patients each day. This level of work is something that would be unimaginable in any other NHS service including A&E, walk-in centres, and GP Out of Hours.
“We are not an unlimited resource; every patient contact takes time and involves a decision-making process.
“Recent British Medical Association and Royal College of General Practitioners (RCGP) guidance is that there is a point where we should declare ourselves ‘full’ when we feel we have reached our capacity to effectively deliver safe care. As a result, we will be making changes to the way we manage urgent on-the-day demand.
“We regret having to take this course of action and we understand that it may be inconvenience some patients, for which we apologise. We are all working extremely hard to offer the best possible service for our patients, with the resources that we have.”
Dr Irfan Malik, a Nottinghamshire GP, said the decision had been made through “sheer desperation” and the NHS now “feels like a sinking ship”.
He told i: “In some cases there are simply not enough staff and GPs/nurses to safely meet this demand for urgent appointments, either face to face or telephone.
“Hence some GP surgeries have made the decision to cap the number of on-the-day urgent appointments, simply to provide a safe, sustainable service. This would mean the overflow patients would have to seek assistance elsewhere. These changes will have been made out of sheer desperation.
“The crisis in general practice has been brewing for many years, even before the Covid pandemic. GPs are reducing their sessions to protect against burnout, maintaining their wellbeing and avoiding the perverse taxes associated with the NHS pensions scheme. This is the perfect storm that many of us have been warning about.
“The huge level of rejections of hospital referrals and ever increasing hospital waiting lists have further transferred extra work back to GPs.”
Amanda Sullivan, chief executive of NHS Nottingham and Nottinghamshire, said: “We are incredibly proud of our general practice colleagues who continue to work extremely hard during these pressurised times, where we are seeing more demand than ever on NHS services.
“We continue to ask the public to use services wisely to ensure those patients with the greatest need can access care and support when they need it.”
It comes after RCGP chair Professor Kamila Hawthorne told i she and other colleagues are now regularly having at least 60 patient contacts per day, in a “new normal” for family doctors. She added: “It isn’t safe and it isn’t sustainable.”
The British Medical Association recommends no more than 25 contacts per day, but practice lists have ballooned in recent years – from fewer than 7,000 patients on average in 2014 to 2015 to more than 9,000 now. Over the same period the number of GPs has fallen.
One of London’s busiest hospitals became the latest to declare a critical incident due to bed shortages on Thursday. St George’s Hospital in Tooting said the move was made to “improve discharge of patients across all wards”.
A critical incident is declared when frontline services are facing intense demand, and means non-emergency hospital treatment is halted.
St Georges – a major trauma centre – said its “emergency departments and hospitals are under extreme pressure right now” and that it was expected to stay that way for months.
A spokesperson added: “Right now – like all parts of the NHS – we are not always able to provide the level of care we would like, and we are very sorry this is the case.”
In a letter sent to staff, St George’s trust chief operating officer Tara Argent said “urgent action” was required and the hospital needed to discharge patients. She urged staff to help identify those who could be sent home or into alternative care.
United Lincolnshire Hospitals NHS Trust – which runs Boston Pilgrim and Lincoln County hospitals – has delcared its third critical incident in three weeks. It aid it took the step due to “significant pressures on services”.
Guy’s and St Thomas’, in London, has been forced to open a critical care surge ward to cope with numbers of seriously ill patients – a move not seen since the height of the Covid pandemic.
Beds in the surge ward would be staffed by a full critical care team, according to a leaked email. Surge wards were used by hospitals during the pandemic to ramp up capacity.
A spokesperson for the trust said: “As part of existing plans for this winter and due to refurbishment works on one of our critical care wards, alternative space for critical care patients has been made available in St Thomas’.
“Our hospitals are very busy and we would encourage everyone who is eligible to get a flu jab and Covid booster this winter.”
A spokesman for the Department of Health and Social Care spokesman said it recognised the pressures the NHS is facing following the impact of the pandemic and was “working tirelessly to ensure people get the care they need, backed by up to £14.1bn additional funding for health and social care over the next two years”.