Winter pressure in general practice: build the surge capacity before you need it

Nobody working in general practice needs telling that winter is harder. What is striking is how measurable the curve has become. An NIHR-funded survey of practices in England found 30% describing themselves as very busy or burnt out by mid-October, rising to almost 50% by early December (BJGP, winter pressures in general practice). Across the wider system, A&E attendances hit record levels in October, running at more than a thousand extra attendances a day year on year.

The pattern repeats every year, and so does the response in many practices: work harder, stretch the rota, hope the flu season is kind. By February the team is exhausted and the spring recovery starts from a lower base each time.

The cost of improvised capacity

When winter demand outruns capacity, the overflow has to go somewhere. Some of it becomes longer waits for routine appointments, which stores up demand for spring. Some becomes same-day pressure on duty doctors, which is where triage decisions get rushed. And a lot of it becomes deferred non-patient-facing work: the documents, results and medication queries that pile up precisely because everyone is in surgeries. That deferred work is next quarter’s backlog and next quarter’s risk.

Locums fill rota gaps, but they are scarce and expensive in winter for the same reason you need them, and they do not touch the invisible workload at all.

What planned surge capacity looks like

The practices that come through winter in the best shape treat surge capacity as infrastructure, not rescue. Remote triage and on-call support that can be switched on when demand spikes, rather than recruited for after it has already hit. Overflow clinics for the season’s predictable workload: respiratory presentations, long-term condition reviews displaced from autumn, fit notes. And a deliberate decision that correspondence keeps moving through winter, so the practice does not emerge in March with a document mountain behind it.

The common thread is that all of this is arranged in October, not discovered as a need in January.

How NovaClinic supports practices through winter

NovaClinic provides remote triage and on-call support, long-term condition clinics, fit note clinics and bespoke overflow clinics, staffed by our GP-led team and delivered inside EMIS Web and SystmOne. Alongside it, NovaDoc keeps the document workload moving when the practice is at its busiest, with up to 98% of documents dealt with without GP involvement.

NovaHS is CQC-registered and clinician-led, supporting practices across 32 ICB areas in England. If this winter has already found the gaps in your capacity, the best time to fix them for next year is while the memory is fresh.