My GP has told me that 80% of their appointments don't need a GP appointment.

That's registered patients, not patients actually needing medical care. There may be fewer patients per GP in deprived/run down areas, but poverty etc means they're more likely to need more medical attention, more GP appointments, etc. Whereas a lot of the London population will be healthy, richer, relatively younger people who may not need to go near their GP anywhere near so often.

'The RCGP analysis found significant variation in the number of patients per GP across the regions in England, with London having the greatest number of registered patients per fully qualified GP at 2,560, whereas the South West has the lowest at 2,020'

According to the link I posted, the key factor for access is more about deprivation than location, and London has some of the worst access.

But even the "worst" areas of London in terms of access to services etc is probably far better than out in the regions where the majority of the population live. I'm utterly fed up of the London-Centric nature of this country - where a MINORITY of people live but who benefit massively more than the majority of people who live elsewhere.

The whole thing is a mess for that kind of reason. The World has changed yet the NHS is still stuck in the dark ages with antiquated rules and procedures.

Another ridiculous rule with physical pharmacies is that the counter staff aren't allowed to hand over a prescription if the actual pharmacist isn't present on site, even if they've been "signed off" by the pharmacist. In reality, the counter staff don't check with the pharmacist every time they hand over a prescription and the pharmacist isn't stood there watching the handover, so I fail to see any logic at all why having the pharmacist on the premises makes one iota of difference.

After all, the pharmacist isn't present at "handover" if the prescription is being delivered by the pharmacy van & man, nor present when the post man hands over the parcel for an online pharmacy delivery.

It's things like that which are dragging down the NHS.

https://www.rcgp.org.uk/News/research-statement-conference-2024

In fact, parts of London may have access issues:

'GPs in deprived areas are now responsible for caring for a staggering 2,450 patients per head – over 300 more patients per GP than in more affluent areas of the country.
New research published today by the Royal College of GPs ahead of its annual conference in Liverpool reveals that the number of patients per fully qualified, full time GP working in areas with the highest level of income deprivation has increased by an average of 260 in the past six years – a rise of 12% and nearly twice the rate of those in the least deprived areas.
The RCGP analysis found significant variation in the number of patients per GP across the regions in England, with London having the greatest number of registered patients per fully qualified GP at 2,560, whereas the South West has the lowest at 2,020'
...
'Professor Hawthorne will say: “Our latest research reveals that GP practices with the highest levels of income deprivation have far greater numbers of patients to care for than in most affluent areas. More worrying, where the need is greatest, we have uncovered evidence of how much worse that GP to patient ratio has become.
“When I became a GP, it was normal to have a list size between 1,600-1,800 patients. The role was busy and challenging, but it was manageable. Our latest figures reveal that the average is now 2,300.
"All GPs work extremely hard, and we would argue that almost all areas are under-doctored, but it can’t be right that a GP in Kingston upon Thames looks after 1,800 patients while a GP in Kingston upon Hull, one of the most deprived places in England, is expected to cover twice that number.'

London has 15.5% of England's population, so 84.5% of people in England don't live there.

Wouldn't it be lovely if the rest of the country had the facilities it has!

I'm sorry but I get sick of it being all about London and a total failure to recognise the problems that the other 75% of the population have.

Its like when its International Women's Day and you get someone going 'but what about the men?'

'But what about London?' as a reprise tends to wind up people who do not have access to the same things.

Its not all about bloody London.

There's no need to be rude.

Oh poor London. So few options available. Just like a semi rural or rural area in the North.

Give me a break.

No, but there is still a far higher likelihood of alternative practices within a reasonable distance than in somewhere like rural west Dorset.
(See also: schools.)

London is not one homogeneous lump with the same amount of GPs and population density in every area...

You live in London. Nothing further need be said.

Yes, it varies. Rural patients may have virtually no choice at all. And some areas are real blackspots, where some practises are not taking on patients at all.

There’s only one other one in my catchment and they have a sign up saying they will not accept patients that are wanting to change from the other surgery

I found it quite easy to change GP. Does this vary by area then? I'm in London. I just had to find one with spaces, where I fell into "catchment".

Econsult doesn't work for people with certain disabilities. That's a bit of an issue if you are undiagnosed. Some patients need face to face because of communication issues not because of medical issues. This isn't being recognised and it should be. Econsult works well for a lot of patients who want it, but it shouldn't be enforced and an a substitute for patients who still want face to face. There should be a way of saying this really doesn't work for me.

What is a really telling sign is that there is a large number of people who will go to a&e for minor ailments and wait for hours upon hours to be seen. You have to examine why they are prepared to do that. It's a strange thing to do for no reason or being 'they don't really need to see a doctor'.

They quite clearly do NEED to see a doctor. They are doing so for a few reasons; their relationship with their GP has broken down possibly due to attitude, they can't access their GP for some reason, they feel they are getting inadequate care from their GP or they have significant health anxiety and need adequate reassurance.

One key issue is you can't just change GP. If you have an arse of a GP with patient skills issues you are effectively often stuck with them. If they take a particular dislike to you or think you are being 'difficult' and have decided you don't have a problem and it's 'all in your head' or are just plain prejudice in some way, you are stuck with them. There's absolutely no recourse. Anyone saying you can change GP has never been through the process. It's a fundamental flaw in the system in this country which I really believe harms patients on multiple levels. GP surgeries are by design local monopolies. They are private businesses which operate within the NHS framework. This also means there are financial incentives for not treating certain things or aggressively pushing others to meet targets. Again there's problems within this.

If people need significant reassurance with their health, it's worth pointing out that anxiety itself IS a health condition. Saying that people with health anxiety are 'timewasters' is appalling in an age where we know that mental health is important. It's backwards. Anyone with health anxiety perhaps does need more time with a GP and it should be seen as time well spent on mental health grounds rather than purely time wasting.

If you effectively scare people off the GP because they've become so anxious about seeing them because you've lectured them to death about 'inappropriate' appointments, you risk harm the time they do need medical care but disengage due to loss of trust. This has implications for particularly vulnerable patients and safeguarding. People take messaging about 'not wasting the doctors time' in different ways - the target for this often are so thick skinned and tone deaf it goes over their heads anyway and it's actually listened to by more diligent groups who already only attend when they should resulting in them failing to book appointments when they start to have an issue and then only doing so when the matter has progressed to crisis point.

One of the issues is no one is really examining the whys on this or measuring the right things to actively identify the problems.

Getting unfit GPs struck off is impossible too which doesn't help matters. When you have creeps for doctors who have been involved in sexual assault cases but they arent struck off, it begs some almighty questions about implications for patients.

I reckon a lot of the "avoidable" appointments also would arise from the gatekeeping aspect: you can't arrange anything like a prescription or blood test or get a minor injury seen often without GP involvement (waiting time in our MIU regularly tops 5 hours - who can manage that if they've got a job?). So they're picking up slack from the rest of the system, because the rest of the system isn't bookable.

This makes no sense. A doctor says 80% of consultations aren't needed. People have posted about times when they have been dismissed, and you say those are in the 20% and not the 80%, even if doctors think they're in the 80%. The 80% can't be true then can it if you agree some of the people counted belong in the 20%.

And this is not the case anyway. Latest figures from 2023 show that from submissions by doctors themselves, the reported figure is 'up to 16%' of consultations that are deemed not needed. And this will include all the people who've been sent away, so in reality that percentage is even lower.

You’re assuming that the patients are able to tell whether or not they need medical intervention for their problem. But they usually don’t have the knowledge to do that and surely that's what the GP is there for. So the 80%, or certainly most of them, aren’t wasting GP time as you’re implying.

I don't think a throwaway comment from your go is evidence of accuracy, just frustration. Have you any research or quantitative data to back this up?

Evidence showed roughly the opposite: around 20% of appointments were 'avoidable'.

You didnt read the links I posted, then.

I work not dissimilar hours to those as a mid career teacher employed 0.8 FTE. If I didn't have that day "off" I'd quickly sink under the marking and admin.

I do get school holidays of course but then probably earn less than half what a GP does.

Public service jobs are like that these days (don't want to say public sector as GPs aren't employed by the state).

For what it's worth, I'm very happy with my GP: they're well organised as a practice, courteous and nice individuals.

I did ask a mate at the PCT which practice they got most praise for/least complaints, before switching to them though!