The “Call Centrefication” of GPs

This blog has been bubbling for a while and reflects my worry that the “Call Centrefication” of our Doctors and General Practices (GP) is and will continue to have, a detrimental effect on our health.  The increasing barriers to access mean I pretty much avoid trying to use my GP now; in fact, recently, instead of using my GP I went online and bought some medication.  It just seemed easier, quicker and less stressful for everyone.

I’ll focus on two aspects here – booking an appointment and the NHS application – all from a patient’s perspective.

For the avoidance of doubt, I am not being critical of any individual or GP practice, it is more my assessment of a range of symptoms of an increasing systemic problem in GP primary care service provision   This is based on my own experience of using (and not using!) Roath House Surgery (where I have been registered since returning to Cardiff in 2000 and have had excellent care once I am “through the door”) and that of others I have talked to (patients, practitioners and administrators) – so, yes all entirely anecdotal, but with perhaps a little informed insight that I hope shines a little light on a growing problem.

I would also add that some have accused me of being demand avoidant and someone who does not take well to over-instruction or unnecessary bureaucracy. It’s one of my “features” or some might say “faults” that I explained in my book.  So, I don’t work well with queues and instructions to call at a certain time.

I am also aware that the GP ecosystem is clearly struggling with the increasing demands on its services.  In Cardiff a 25+% increase in the city’s population since 2000 (from circa 305,000 to 380,000) is also adding to the mix and clearly adding to the demand on GPs. However, I also perceive a resistance to change, and an increasing bunker mentality given the pressures.

Let’s also remember GPs are not really part of the NHS, this is the compromise agreed way back at its inception in the 1948.  The majority of GP practices in Wales are run by independent partnerships who are contracted by the Health Boards to provide medical services according to the General Medical Services contract (GMS contract).  Following the conclusion of the recent disputes the current 2025/6 GP contract provides for an average weighed funding per patient per year of £136.   That doesn’t sound very much, does it? So a GP with 10,000 patients  (which is likely in Cardiff) will get £1.36M pa.   There are also other functions and funding streams, but that is the headline. It may sound a lot but that has to support several doctors, staff/receptionist costs, building/premises costs, etc

The new agreement also includes certain provisions – for example related to patient access to their own data.  I’ll come onto that below.

Booking appointments

Over the last few years, I have noticed how incrementally difficult it is to get an appointment.  Now it seems, many GPs have wrapped themselves in a call centre process with specific rules on how one engages them – especially when and how. If you don’t follow these rules, no way in.   This process, it seems to me, is designed around the administration of the GP and not the patient. I probably only call upon my GP once or perhaps twice a year?  But now I tend not to bother.

I and many others, find getting an appointment much more challenging than it used to – and don’t try emailing (I have done that to death) or actually turning up at the surgery (that doesn’t work either) …and forget using the NHS App.

The only way to get an appointment on the day is to call at 08:00 and wait in a queue after being subjected to 2-3 mins of instructions and guidance (mandated I believe by Welsh Government WG).  Whether intended or not, I suspect this puts people off and suppresses demand a little (certainly in my case!).  I now understand one can press a call back request after the pre-recorded information and avoid endless hanging on.  Once you get through one might be told all the appointments have gone. One can ask for a Dr to call and then have to try explaining symptoms to a receptionist who then shares with a duty doctor as part of an initial triage process.  I do get it – GPs get a lot of calls.  However, I think many patients would rather be explaining their symptoms to a medically qualified individual?

Similarly, one can’t book a later “non-urgent” appointment unless once calls at 2pm on specific days and again have to listen to 3-4 mins of general guidance and information.

I have emailed asking for a non-urgent appointment in the past – which I think should be actioned via the App.  I have had some non-urgent issues re my enlarged prostate (I am 63!), some skin issues I wanted to check after applying a course of Efudix and at one point had some blood in my faeces (apols for the gory details).

But no, in the email response from the surgery, they informed me they could not action my email and told me to call at 2pm to book an appointment! They already know I want an appointment, having read my list of issues, and agreed I should get an appointment.  However, because of the process they still insisted I had to call at 2PM.  I refused and paid for a private test for my faeces and have let the two other issues remain unchecked – at least for now.  In the last few weeks, I had another issue…. I didn’t even bother calling the GP, I went on-line and bought some medication that way – it was quicker and easier.

Following a request for a repeat prescription (which is perhaps the only thing the NHS app is good for at the moment) I also got a text from the surgery saying that I should book a blood test?  So, I emailed them asking for one as they suggested – so far, no response or reply.  I really don’t want to engage with their system/process and have to endure 2-3 mins of guidance and warnings, be left in a queue and then have to jump more “triage” hoops” via the receptionist.

I still need that blood test as its been nearly two years since I checked my cholesterol level.  I remember in the old days I would often book a follow up Drs appt at the surgery after giving blood for perhaps 2 or 3 weeks in advance when results should be available.  Can’t do that now!  There is a little Kafkaesque bureaucracy creeping in, I think.

Another anecdote, someone I know with an older relative who had been bitten by a dog, called a GP and asked if they could come in that day for a tetanus injection.  They said they could try book an appointment for later in the week if they called at the appropriate time,  or go to A&E (with its very long waits). Instead, they paid and went to Spire the same day and were dealt with very quickly.

I also hear that on occasion some patients don’t always enjoy a warm “welcome” at a front desk.  If you walk up to the desk, rather than being blanked/ignored for 2-3 mins a brief “hello I will be with you shortly” will really help. Nor do patients want to be discussing personal health matters in such a public environment.

I do know that front line NHS staff often face abuse and sometimes threats and actual violence from some patients, so I can appreciate the reticence on occasion.  However, in a clearly non-threatening environment/situation, just looking up to acknowledge someone is really important.  We actually changed our opticians in the past because of the rather “abrupt” interactions with reception staff.

The “call centrefication” of the GP and the “holding patients at arm’s length” I find very frustrating and something, especially givens its strict “rules of engagement”, is off putting to many people – me included.

Maybe if one underfunds health services and GPs for 15 years this is what happens?

The NHS App and whose data is it

Let me be clear, any patient data, no matter what, I consider belongs to the patient. As such patient access to it should not be an issue or subject to unnecessary hoop jumping.

Under the provisions of the relevant Data Protection Act, whilst GPs, NHS, etc may “control data” the patient (the data subject) has a right to access ALL data for free.  I am not sure one feels that is actually the case in practice.  This contrasts with the NHS (and esp. the NHS app) in England which provides far more patient information by default. 

I have had a little contact with NHS Digital Healthcare Wales, and they tell me that the degree of functionality available to patients on the Wales NHS App is controlled and determined by individual GP surgeries (so not NHS Digital Health Wales, Welsh Government or even the Health Boards). 

There also appears to be significant variation in how GPs engage with the Wales NHS App and how their myriad systems interact with it.  Seems to me to that too much fragmentation in NHS systems and processes in Wales overcomplicates what should be “relatively “easy to address(!).

Even more relevant the new GP contract explicitly states:

• Patients will have access to a summary patient record including allergies, immunisations and health conditions (excluding free text and test results) via the NHS Wales App.
• Subject to agreement on processes, this will be rolled out before the end of March 2026.

For me this should cover ALL data and test results – not just summary data.  It’s my data after all.  This is fundamental.

Implications…

It appears to me that NHS services/functions are too fragmented and “function” centred.  We need a more patient centred service, in which the role of GP could become far more important in in brokering and managing the secondary services a patient may need.   Underpinning this requirement is a need for far better and integrated patient centric IT systems and processes.

The alternative is that AI and the emerging call centre wall being put up around GPs, drives people to on-line and unproven AI tools and/or for people to default prematurely to A&E further exacerbating demand and capacity problems there (which merits some attention as well!).

To conclude

It seems to me the entire HNS in Wales is held back by dated IT systems, processes and a lack of integration thereof – all getting in the way of a better patient focused service. I also think a degree of cultural resistance and inertia in the Health ecosystem is not helping either.  

In 2026 I should be able to request a non-urgent appointment via the NHS app, see my full primary and secondary care medical history, including test results, procedures, to see where one is on a referral list, prescriptions, medications, dental records, ophthalmic records, etc. 

With AI now becoming ubiquitous, then simple personal diagnostic analysis should also be perhaps part of the offer (that could take pressure of the GPs). Many people are doing this anyway in a less “controlled and systemised manner”

Little or none of this is currently available. I suspect most of the myriad of systems and processes in use are just not up to it? And many people seem disinclined to embrace the degree of change required. I’m not going to get onto the institutional/operational  fragmentation, governance weaknesses, etc of the NHS in Wales (eg Wales has seven health boards, three trusts, a separate ambulance service, etc…), or the “elephant in the room” of Social Care.  There is much that demands intervention.

I know this is not easy – and the massive failure and costs overruns of the NHS England IT system way back in 2013 provides a salutatory lesson. Some suggest at that time as much as £6Bn was written off. However, it seems NHS England has learnt a lesson and moved on from that debacle with many patients now using much improved systems.  In Wales, NHS Wales and its GPs…. It would appear not so much!

I also think, as a 63-year-old man, that if we are to take preventive medicine seriously, “people of my age” should be getting a bi-annual, or even an annual check-up and a raft of screening diagnostic checks.  This is clearly not really happening systematically.  I also think it is people like me who are actually turning away from engaging with GPs and either paying themselves or not bothering at all, risking more serious outcomes and additional larger NHS costs later.

More radical perhaps, if the GP ecosystem can’t grasp the change opportunity, maybe WG should consider a new model of primary care as an alternative?

Much to ponder for a new Welsh Government.

PS An example of something that seemed to work…

I also think it worth sharing an example of something I thought worked, relatively, quite well as an alternative to the very long waits in A&E (Another very thorny issue). About 8 months ago I fell whilst running and did some serious damage to my ankle and could barely walk with an ankle growing to the size of grapefruit! After struggling for a day and having been harangued by family members, I called 111 (I couldn’t face A&E, nor the GP process). Yes, there was an infuriating wait. However, after a brief discussion I was booked into the minor injuries’ unit in Barry (I think first thing the following day, or maybe the day after). I went to Barry Hospital at the appointed time and was seen and X-rayed withing about 20 mins, a further 10 mins later I had seen a qualified medical person to confirm it wast not broken – but very badly strained. I was in and out in about 40 minutes! Had I been in A&E that could have been more like 6 hours!