Why can’t I get an appointment with my GP?

The difficulty with getting a GP appointment – the 8am scramble to get through to the surgery, and the long waiting time on hold only to discover the appointments are fully booked – has become a universal conversation topic on par with bad weather. Sometimes it’s just downright frustrating but the consequences can be profoundly serious.  

The problems are not just anecdotal – Scotland-wide surveys have shown in recent years an increasing number of people find it hard to get hold of their doctor.

The pressing need to address the problem was raised several times in last week’s budget, with Shona Robison, Scottish cabinet secretary for finance, claiming that reducing waiting times was a key target of additional spending. She claimed a “bigger share of the health budget” was this year going to primary care, with extra millions put aside for investment in more GPs and better funding other costs. 

The Scottish Government said it was committed to “ending the 8am rush” and also put aside £36m to begin the rollout of new High Street “walk-in GP clinics”. But will these developments help? And why is it so difficult to get an appointment with a GP?

Staffing

The most straight-foward answer lies in the data. The actual number of GPs – the so-called headcount number – was 4,582 as of last March 2025, excluding trainees. But this is the equivalent of just 3,592 full-time positions. That’s because of the proportion of GPs who work part-time, sometimes due to parenting and other caring responsibilities.

That number is a slight increase on the previous year. But the general trend has seen GP full-time equivalent numbers decreasing. Ten years ago Scotland had slightly more GPs than now with 3,604 full time equivalents seeing patients.

In the same time frame patient lists have been growing. Scotland’s population has increased as a result of migration. Though life expectancy stalled during Covid, general trends show that people in Scotland are also living longer. In total the number of people registered with GPs has increased eight per cent between 2015 and 2025.  

The net result is there are fewer GPs in Scotland per person than there were five or ten years ago. While in 2015 there were 1,562 patients per GP on average, in 2025 there was just one GP for every 1,685 patients.

Within these averages there are winners and losers. Regional data shows that in NHS Lanarkshire practices there was an average of 2,381 patients for every whole time equivalent GP in 2024, making it statistically far more difficult to get an appointment there than national averages suggest. In some Lanarkshire practices those patient-per-GP numbers are even higher, sometimes significantly, though the use of locums – temporary GPs – and other healthcare staff makes it difficult to give accurate comparative numbers.  

At the other end of the scale – and the country – NHS Orkney was able to provide a GP for every 662 patients. Again, variation will be seen in individual practices on the islands. 

The British Medical Association (BMA) claims Scotland would see dramatic improvements in health and wellbeing if there was one GP for every 1,000 patients. 

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Increasing complexity 

But it’s not just a numbers game. As Dr Iain Morrison, chair of BMA Scotland’s GP Committee, explains, Scotland’s population now also requires more complex care. 

“As people live longer they have more complex conditions,” he says, and many of them have more than one issue at the same time, known in medical terms as comorbidities. On top of that “there are more treatment options and the growth in the associated healthcare required is exponential”. In other words we now have fewer GPs – but more patients with more complicated healthcare needs and more treatments available. 

In total there are now 1,186,099 registered patients in Scotland who are over 65, almost 20 percent of the total number. That percentage has been rising steadily for more than a decade. In many practices, more than a third of patients are in this age bracket.

Deepening poverty in Scotland is another factor. A clear link has been established between shorter health lifespans – that’s the number of years you live without health problems – and living in poverty.

Patients then experience this as ‘I can’t get an appointment’, even though practices are working flat out.
Dr David Blane, The Deep End

According to David Blane, from the Deep End GPs network – which is made up of 100 practices in the most deprived areas of Scotland – this means that in areas of high deprivation there are often more complex consultations which take in various physical and mental health conditions as well as trauma and social problems.

A vicious cycle is created, with complicated problems requiring longer consultations, which leads to fewer appointments and results in more unmet need. “Patients then experience this as ‘I can’t get an appointment’, even though practices are working flat out,” he says. “So, pressure isn’t just about volume.” He claims it is also about "complexity, intensity, and moral strain", that's the psychological distress felt with your core beliefs don’t chime with your actions – in this case wanting to provide good care but not having time to. “GPs are constantly balancing high clinical risk with limited time, which is exhausting and contributes to burnout and workforce loss,” he adds.

Supporting other health conditions 

According to the BMA’s Dr Morrison there’s also higher demand because of better understanding about a range of physical and mental health issues.

“There are now new areas of medicine that drive further demand,” he says. “HRT consultations [for women experiencing menopausal symptoms] have exploded in the last five years, for example. That’s not to say the need wasn’t there before that but there is now a greater awareness. That has benefited women but those appointments are coming from the existing resource.”

According to the most recent Scottish Health Survey, about six in ten of those who had experienced any menopause or perimenopause symptoms had sought help, most commonly from their GP. However 15 per cent of patients said they had not done so because “they did not want to burden the NHS,” suggesting an even greater need. 

Consultations about neurodiversity are another area of exponential growth, according to Dr Morrison. Drugs used to treat ADHD, such as Ritalin, were prescribed to 25,904 people in 2022/23 but that increased by about a third to 34,440 in 2024/25. “Again, this has to be managed by GPs without additional funding,” he said. 

How practices are run 

The number of GP practices in Scotland has decreased by almost 9 per cent from 969 GP practices in April 2016 to 887 in April 2025, reflecting a trend towards fewer, larger practices overall.

This means that you are more likely to be in a practice with several GPs, lowering your chance of getting the same one every time. The importance of consistency is highlighted in patient satisfaction surveys and evidence also shows that GP relationship continuity – seeing the same GP every time – improves access to appointments and helps address health inequalities. 

GPs practices, which operate as independent businesses contracted and funded by NHS health boards, are all managed differently with varying stipulations about how far ahead it is possible to book, or how urgent appointments are allocated. 

Some practices offer phone appointments as standard in the first instance, following up with in-person appointments as necessary and others allow patients to specify which they prefer. According to the most recently available statistics from 2023/24 only 62 per cent of appointments were face-to-face, with the level of phone appointments dramatically higher than pre-pandemic. Some research has suggested that while phone appointments can be convenient, they have poorer outcomes and create more admin work for GPs.

Some GP practices have also made greater use of multi-disciplinary teams, sometimes using less qualified – and less expensive – healthcare professionals, like physician associates, who are supervised by GPs, to meet growing demand. But while additional roles can add value, using these instead of hiring additional GPs is not recommended by the BMA. 

What about the funding?

In December the BMA and the Scottish Government agreed a package of funding between 2026 and 2029 that will give general practice an annual increase of £250m by 2028/29. Dr Morrison says this will help to “stabilise the situation” and is a very welcome “first step”. However he insists it is nowhere near enough to bring about the reform needed. The Royal College of General Practitioners (RCGP) Scotland chair Dr Chris Provan also welcomed the funding, but has agreed with his assessment.  

The funding deal will see the NHS budget allocated to GPs rise from approximately 6 to 7 per cent, but a decade ago that figure was 11 per cent. The BMA estimates that about £1bn would be required in order for Scotland to provide one GP per 1,000 patients.

Both organisations are sceptical of Scottish Government plans for 15 walk-in GP clinics across Scotland, the first of which, it was announced last week, will be at the Wester Hailes Healthy Living Centre. The scheme, and a £36m funding package to pay for it, was announced in the Scottish budget and will offer over a million GP and nurse appointments, about 0.3 percent of the Scottish total. Concerns have been raised that it will funnel money away from the core system. 

Dr Blane of the Deep End also claims the new funding package is “insufficient to address healthcare inequalities” and will not “fundamentally correct the current mismatch between need and resources”. He says funding should be better weighted in favour of practices with the biggest workloads.

Is there another way?

“We have to deliver a lot more care in the community,” according to Dr Morrison who believes that with the right kind of reforms in place, a far better system is possible. In the BMA’s vision, GPs, assisted by the access to knowledge that AI provides, could be more involved in outpatient care for the increasing number of people with more than one health complaint. “Instead of seeing a whole range of specialists who are not able to look at people’s conditions holistically, GPs could be managing their care and the logistics of that for them, making sure patients get the care they need,” he explains. “That will take substantial commitment to change and resources to match.” 

That would lead to better and more holistic care, cut down on waiting times and free up GPs who currently have to offer care while people wait.

He admits it’s a culture shift. “At the moment practices are stuck with 10 minute appointments, squeezing home visits into lunch breaks,” he says. “Hospitals are at capacity and that is not going to change. We are still talking about A&E as the front door of the NHS but instead we need to start talking about health care starting at the patient’s own front door and work from there.” He points to examples in Nordic countries such as Sweden, which has put a firm focus on primary health care, supported through what would once have been known as cottage hospitals, allowing aging populations to access quality healthcare in their own communities.

As for poorer communities Dr Blane claims that the need to frontload resources into deprived areas is paramount, with targeted recruitment in these most challenging practices along with mentoring and support to prevent burn-out. Critically, he claims we need to stop treating the problem of getting GP appointments as “a simple numbers and speed problem”. 

He adds: “Good access also depends on consultation quality – seeing a GP who knows you well improves your experience, your safety, your quality of care, your health outcomes.” GPs need to have time to deal with complex issues and to be able to offer “inclusive, flexible, person-centred” care. He insists: “Without addressing those, appointment shortages will persist, particularly in the communities that need care most.”