Box 1.

Policy changes

NHS England — letter On 13 May 2021 — when the second wave of the pandemic in the UK (largely driven by the Alpha strain of SARS-CoV-2) had subsided — NHS England announced that GP surgeries had to ensure they were offering in-person appointments, with patients being allowed to choose whether they see a GP in person or remotely.9 In-person care could, however, be denied where there were ‘good clinical reasons to the contrary’,9 such as the presence of COVID-19 symptoms. GP reception areas would once more be open to the public to enable those without easy access to phones or other devices to book an appointment, but physical distancing would remain in place. These instructions contradicted guidance from Public Health England, also published on 13 May 2021, reminding the public to ‘work from home where you can’.14 NHS England — government directive On 14 October 2021, NHS England, in collaboration with the Department of Health and Social Care, released its directive to improve GP access, with focus on increasing the number of in-person consultations.9,12,15 The directive followed ‘Freedom day’ on 19 July 2021 when, despite the high levels of Delta strain circulating in the community, most restrictions (for example, limits on venue capacity, physical distancing, and mask wearing in most situations) had been lifted and the public was encouraged to discontinue remote working.2,16 More comprehensive than the May letter, the main component of the directive was a £250 million winter access fund available to GP surgeries that submitted applications stating how they would endeavour to increase the number of in-person consultations during the upcoming months. The funding could be used to improve access by, for example, hiring more locum GPs, other healthcare professionals (for example, nurses, physiotherapists, and podiatrists), and/or administrative staff. Other aspects of the plan included short-term solutions, such as reducing GPs’ administrative tasks and enabling pharmacists to prescribe medication for minor ailments, and long-term solutions, such as recruitment and retention initiatives for GPs and other primary care health professionals. Other components included ‘levelling up’ GP services through measures such as patients rating their experiences, and the public release of performance data; improved communication to help patients understand how to access primary care for their specific needs; and a zero-tolerance campaign on violence and abuse towards NHS staff.