One of my patients this week had waited over an hour on hold to book their GP appointment. Sadly, this is now far from unusual. Long waits to get through on the telephone are commonplace at my surgery and many others nationwide. My patients (understandably, after such a battle to be seen) are frustrated, disappointed, and sometimes desperate. I find myself sharing their despair, and I worry about all those who cannot get through at all. How have we created such an inaccessible system?

A lot has been written about NHS England’s decision to focus investment on online access, with surgeries paid to deliver these appointments in increasing numbers, much to some patients’ annoyance.

Less understood, however, are the consequences for GPs’ time. I spend hours every day going through countless “e-consults”, online consultations submitted through the practice website. When it can be easier to consult a GP online than it is to buy paracetamol, demand for our services has, obviously, never been higher.

The average patient consults their GP more than twice as often as 20 years ago, and the number of appointments provided by general practice has risen steadily over this period. We have an ageing population with multiple comorbidities: this trend is set to continue.

Yet GPs’ time is not always used well. We are frequently consulted about non-medical or trivial issues. One patient recently asked if I could provide evidence that she needed to take her cat shopping with her (for psychological support). Others ask for advice on sore throats or stomach aches, sometimes even in the first hour of having the symptom.

When a patient presents early in their illness, it may be impossible to tell if a 20-year-old with a stabbing pain has ruptured their appendix, or simply has trapped wind. I can’t dismiss the concern once it has been raised; but many patients seek help prematurely or fail to take simple steps to self care. As a GP, I regularly find myself dealing with insignificant concerns, while apologising to genuinely ill patients that they cannot be seen in a timely fashion.

I frequently have to manage patients remotely, when I would feel more comfortable offering a face-to-face appointment, because capacity is so stretched. All too often it is older patients, unwilling or unable to access remote consultations, who have difficulty getting through. Patients with the first signs of cancer struggle to get appointments. Palliative patients ask for help, but home visits are now rare, and GPs have to rush in and out (if we can attend at all).

This is as demoralising and unsatisfactory for doctors as it is for patients, and many of my colleagues are giving up. Something has gone deeply wrong with our service.

A health service that is free to access would be a national asset, if delivered efficiently and to a high standard. But we are no longer providing universally safe or accessible care. Everyone suffers when a health service is overwhelmed; and now it is those with the sharpest elbows, and the smartest phones, who find their way through.

Other countries with better outcomes, and lower health inequalities, apply a small fee for consulting a GP. They have, presumably, found it beneficial to encourage their populations to self care before visiting a doctor; reserving health services for those in genuine need.

A recent survey showed that four in 10 GPs believe that fees would improve our service (four in 10 were against, with the rest unsure). This level of support for a departure from the status quo speaks volumes.

Next year will undoubtedly prove the most difficult the NHS has faced. If one considers the challenges – an ageing population, with a backlog of care exacerbated by the pandemic, alongside ongoing GP and hospital staff shortages – it is clear we must do things differently.

A means-tested fee could improve GP services for everyone, by reducing trivial presentations, and creating more capacity for those most in need. If we want a GP available to help us in the years ahead, those of us who can afford to should be asked to pay.

Dr Katie Musgrave is a GP in Plymouth