Now that COVID-19 case numbers are falling in the UK and lockdown restrictions are being eased, the health service might think that work pressures are beginning to slacken.

No such luck. It seems that demand from patients is intensifying and problems that patients have put on hold and tolerated during the past few months are now coming to the fore.

Practices were already starting to use digital approaches for patient contact before COVID, but the pandemic has accelerated this trend. Now that it’s easier for patients to access practices digitally to acquire speedy responses, it seems this in itself has increased demand.

Of course, more and more patients are getting in touch about mental health issues now too. Waiting times for secondary care have grown sharply, prompting calls for referrals to be checked or sent elsewhere. And practices are still neck deep in organising COVID vaccinations… You can see why demand is escalating.

Rising demand

A practice manager from Surrey Heartlands, who wishes to remain anonymous, agrees that patient demand is rising sharply, commenting: “We’ve seen a big rise in the level of demand. We’re a digital triage practice so everything goes via our website, meaning that we can track what our demand is.

“If we look at where we were for April, May and June in 2020, our figures were around 2,500 maximum contacts per month. We’re now up to nearly 3,500 per month. In March, it’s gone up to 4,000.

“It could be that once the COVID pressure eases, demand goes up because other things come back, and it’s also to do with schools because people don’t want to bring their children with them to see the doctor.

“People are now coming forward with all sorts of stuff. We know from our numbers what we can cope with in a day and if the numbers are going up every day, then we have to get enough clinicians in to be able to cope with that because we never shut anymore. With digital triage, you can’t say no and the phones are open from 6.00am till 6.30 at night.”

Nicola Davies, practice manager at The Roseland Surgeries in Cornwall and co-founder director of the Institute for General Practice Management, says: “Demand has massively gone up and part of that is people thinking that it’s service as normal, and that isn’t quite the case.

“We’re busier than we’ve ever been, but I think that’s clouded by the fact we’re making and receiving more calls about COVID vaccinations.

“A lot of people have stayed away from the surgery because they felt, rightly, that they needed to stay safe and stay in their own homes, but at the same time, they’ve been managing conditions that do need some input.”

Helen, a practice manager in Eltham, London, states: “The Easter weekend wasn’t too bad but demand is going up. We’re getting busier. Demand is rising but it’s difficult to see why.

“Perhaps it’s people becoming more confident to come forward or perhaps it’s people taking the opportunity. If we’re a doctor down, we’re starting to notice it more.”

Time to change patterns

Managers are having to wrestle with another issue too: Should practices return to their pre-COVID work patterns, or should they try new approaches and seek to keep some of the changes that COVID necessitated – for example, more remote consultations?

Nicola comments: “We’re recognising that we probably do need to see more people face to face to make sure we signpost them appropriately at the point when they phone into the practice.” She says she’s noticing that “people are understandably cheesed off. They don’t want to have a phone call with the GP and they want to see somebody, and the trick is finding the balance… It’s educating patients to make them understand that the landscape is moving and things are changing again. We’re now in a position to deal with a patient in a much more efficient way and that may well be a phone call or a video consultation.”

The manager from Surrey explains that their practice began piloting its digital triage system in February of last year, just before the COVID lockdown:

“The system has helped to filter out unnecessary consultations. We can also offer patients the choice if it’s something that can be dealt with by Livi [GP video consultations via an app].

“One of the reasons we’ve gone to the digital triage system is because we can deal with more. It’s quicker because you don’t get the people coming in just because they want to.

“It’s possible that people are now thinking the world is getting back to normal and the risk of catching COVID is getting less, so maybe they’re thinking ‘I’ve had this niggling back problem or whatever for two months so I’m going to get it looked at now’.

“We will do a face-to-face consultation if it’s necessary and we have been doing that throughout the pandemic, although we have been triaging. With the demand as it is at the minute, we’re going to have to do something else because we can’t carry on like this.”

Patients’ habits changing

How patients choose to approach and use practices may also be changing due to the impact of COVID over the past year, argues Nicola.

One of her GPs was contacted after 5.00pm on the Thursday before Good Friday by a patient about their ongoing knee problem. The patient demanded that the GP chase a secondary-care referral because they hadn’t received an appointment – an example, she says, of patients making themselves heard now that the COVID threat has receded.

“We’ve created a 24/7 lifestyle and environment, and some people are saying ‘I want my doctor to be available when I want them’,” she explains.

“We have to make that judgement about what is safe but what is clinically acceptable. Do we need to get people in all the time and can we go back to doing what we were doing, or can we do things slightly differently which might make us more efficient?”

Helen adds: “Patients are starting to be a little less happy about remote consultations and they’re less inclined to cooperate with e-Consult.

“Our patients aren’t backward in coming forward, but they’re very backward in coming forward when we want them to come in for reviews! For example, we did about 50% to 60% of the number of smears that we would normally do in a year because that’s not an acute issue for people.”

In summary
The coronavirus pandemic has left its mark on the NHS and on patient behaviour, but with demand in primary care creeping back up, this is perhaps the time to pause and review how practices operated both pre-COVID and then during the pandemic. Perhaps it’s through combining the best aspects of both approaches that practices will now cope with the increasing patient demand.