I should start by being very clear - the doctors, nurses and other medics in GP practices and hospital A&Es are doing their best.  I've heard "unprecedented circumstances" more than I ever thought I would in my lifetime, but it is true that's what the NHS has been facing. The nature of those circumstances and challenges has changed over time, sometimes in ways that couldn't be predicted and at a rate that couldn't be foreseen. 

The nature of the public health challenge now is different to what it was 18 months ago. The latest data about A&E wait times shows patients are waiting longer than 4 hours. At the same time data, publications and real-life experience shows patients are waiting an hour on the phone to get a GP appointment, days or weeks for that appointment and then some appointments are by telephone when really, they should be best face-to-face.

I'm not going into any of the politics behind this (readers will be pleased to know!).

A few points from the latest A&E data for September:

• Over 450,000 patients waited more than 4 hours from arrival at A&E until their treatment was completed, or a decision was made to admit them;
• However, almost 1.4 million patients were treated, or the decision was made to admit within 4 hours;
• Almost 105,000 patients waited between 4 and 12 hours to actually be admitted to a ward from the time the decision was made. This time could have been spent waiting on a trolley in a corridor.

At the same time, GPs are under pressure trying to see patients and get through a backlog. Some patients cannot get an appointment with their GP at the time or in the way they need it. There are lots of reasons for that being the case but ultimately it boils down to mounting risks to patients' health. Rightly or wrongly some of those patients who want to see their GP but can't, will instead go to A&E, adding to the pressures there.

I've heard from someone at a GP practice local to me (not my practice I hasten to add), who was number 97 in the queue to speak to the GP receptionist. They waited an hour just to get through to ask for an appointment.  Some of the people in that phone queue will have had time-sensitive health issues, such as a baby developing sepsis. 

I don't have the solution, but I would suggest a starting point would be more staff on the phones in GP practices, with medical training to be able to triage the calls from the outset and signpost where necessary.

The Royal College of General Practitioners chair, Professor Marshall said: 'We knew we were unlikely to get a silver bullet to solve all the challenges GPs and our teams are facing, but we hoped to see more tangible solutions to improve the care that can be delivered to patients."