The Primary
Care Crisis

In online conversations about workload from January 2019 to December 2023, two themes dominated, 'pay' and 'time', each appearing in more than 5,000 HCP posts. Most centred on pay failing to match workloads, and calls for pay restoration after a decade of real-terms cuts.

Concerns about 'time' were more varied: rising demand unmatched by resources, and criticism of the ten-minute appointment target as too short for increasingly complex needs. 'Burnout' appeared almost 2,000 times, underlining the depth of the crisis.

Provision has shifted markedly since Covid-19. In-person appointments have returned to pre-pandemic levels but now account for only 70% of the total, while virtual appointments make up the other 30%, a significant overall increase in care delivered.

Telephone appointments fell slightly (9.7M in April 2021 to 7.4M by August 2023), while video consultations grew sharply, from 111,000 to 650,000 over the same period. HCPs remain divided on whether virtual provision can match face-to-face care.

When HCPs discuss the barriers behind industrial action, 'pay structure' dominates by a wide margin, with nearly 5,000 posts between January 2021 and October 2022, spread evenly across nurses, allied health practitioners and GPs.

But pay is the tip of the iceberg. 'Work environment' surfaced in several hundred posts citing staff vacancies, overwork and burnout. More alarmingly, some described a 'toxic' or 'abusive' culture, including reports of nurses threatened with disciplinary action for backing strikes.

Analysing more than 2,600 posts from over 1,000 HCPs, support for the junior doctors' strike reached a record 94% approval, with just 2% opposed, a marked rise on earlier rounds of industrial action.

By comparison, the June 2023 consultants' strike drew 60% approval (28% neutral, 12% opposed), and nurses' strikes 84%. Nurses and GPs were the most proactive in voicing support online.

Technology generated more than 10,000 HCP posts about the NHS. General AI tops the conversation with almost 6,000 mentions, well ahead of digital consultations, virtual wards and robotics.

These discussions are not new; they significantly pre-date Covid-19. As early as 2019, HCPs were already debating technology as a way to save time, from speeding up data collection to digital consultations.

Posts weighing whether AI could become a key tool for the NHS have peaked, but opinion remains vastly divided. At its height, more posts played down AI's potential than backed it as a fix for the service.

In late 2023, a number of HCPs suggested AI might only prove useful once the 'technology basics' are properly learned and rolled out first. Unanimity on AI in the NHS remains some way away.