Health inspectors have raised concerns about the millions of people who could have missed out on care as a result of the Covid-19 pandemic.
The Care Quality Commission (CQC) warned that the number of “lost” appointments could mean that millions of people have not seen their GP.
Cancer diagnoses could have been delayed and long-term conditions could have become worse, it said.
Since the start of the pandemic, there were around 26 million fewer appointments at GP surgeries, according to NHS Digital statistics.
Between March and August last year, there were 146.2 million appointments made at GP surgeries in England.
But between March and August this year, there were 119.5 million appointments made – though the data is still experimental due to the effects of the pandemic.
The CQC said a combination of factors could be at play, including people putting off seeking help, people being “inadvertently dissuaded” by signs on doors of practices and some patients having trouble accessing care through the phone or online.
Inspectors said that more must be done to find those who could have been missed.
It comes as the CQC launched its annual assessment of the state of health and social care in England.
The report highlights a “volatile picture” of deterioration and improvement in GP practices – with a similar number of practices deteriorating and improving in their ratings.
While the majority of GP surgeries are rated as “good”, CQC chief executive Ian Trenholm said there were long waits for routine GP appointments even before the pandemic.
He said: “When lockdown happened, there was a real focus on Covid support and I think we would all argue that is absolutely the right thing to do.
“But it does mean that it has generated a backlog, and it means that people were not able to access the screening, the diagnosis and of course the treatment that they need in order to cope with conditions like cancer and other long-term conditions.”
He added: “As the country locked down, the number of GP appointments fell significantly.
“And there was a very definite move from face-to-face appointments (to) the telephone or video online
“Although there are an increasing number of GP appointments available and GPs are working incredibly hard to get that number up to pre-Covid level, the reality is it’s probably not there yet.
“If looked at across the whole of the year, the number of lost GP appointments translates into millions of people potentially not seeing their GP, not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer, and other conditions.
“And it means that people’s long-term conditions that they relied on their GP to to support them with in terms of its management, that has not happened as well which means that people’s long-term conditions are maybe not as in control as they once were.
“Each of those appointments tracks back to an individual person.”
He added that the health and care system needs to ensure that “no-one is left behind”, adding: “There needs to be an active effort to go back and look for those people that are maybe sitting quietly at home that maybe have a lump or a bump and haven’t gone to see their GP.”
Mr Trenholm continued: “We want to make sure that there aren’t inadvertent signals being given to people – signs on doors or talk about services being restricted because of Covid.
“There is a combination of making sure that we’re not inadvertently dissuading people from receiving services, but also talking openly about the fact the NHS is open for business, and people should come in if they are in any way worried about their treatment (and) the NHS are worried that people are not coming forward.”
Dr Rosie Benneyworth, the CQC’s chief inspector of primary care, said: “We know there has been a reduction in cancer referrals and that is likely to have an impact longer term on people getting appropriate cancer diagnosis and treatment.
“We know that people sometimes haven’t had their long-term conditions followed up, and that is likely to also have a long-term impact on their conditions as well as short-term impact of their long-term conditions not managed appropriately, such as asthma and diabetes.
“We are following up concerns where we are hearing any concerns being raised about access to general practice, so again please do feed back concerns through our feedback on care service.
“We want to ensure that all providers provide appropriate access for some people, digital access is brilliant, online consultations and phone calls can be much more convenient and it has been great to see a growth in that.
“But it does not meet the needs of all people using services, so we need to make sure that if people need a face-to-face appointment they can access one and people get the appropriate care in a timely way to meet their needs.”
Meanwhile, the chief inspector of hospitals Professor Ted Baker said frontline emergency medics had told him that “it feels like winter has arrived early” as the NHS braces to tackle a second surge of Covid-19 cases.
Commenting on the report, Dr Jennifer Dixon, chief executive of the Health Foundation, said: “The CQC’s report illustrates the heavy toll the pandemic has taken on NHS and social care services despite heroic efforts from health and care workers.
“Even before Covid-19, a decade of underfunding and understaffing had undermined the resilience of the NHS and led social care to the brink.
“The casualties are people. There is now a huge and growing backlog of people who need NHS care, which has built up because of the pandemic. The Government must not underestimate the time and investment that will be needed to tackle this very visible waiting list, with the avoidable suffering it represents.”