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Antidepressant 'exaggerated'

Unrepentant GPs insist they have no spare capacity to offer advance slots to meet 48-hour targets ­ by Nerys Hairon

Practices are adamant they have no alternative other than to restrict advance appointments as long as the Government maintains its 'ridiculous' access targets. GPs said they had no spare capacity to offer pre-booked slots and meet the 48-hour target.

The unrepentant stance came after a Department of Health official said the problem was a 'big issue' which was of concern to Prime Minister Tony Blair.

Gary Belfield, head of primary care, told a recent conference restrictive booking was 'against the spirit' of the access target and the department was 'doing work' to stop it.

But GPs said their actions were 'an inevitable consequence' of the access target.

Dr Stephen Amiel, chair of Camden and Islington LMC, said his north London practice tried to operate a mixed system but patients still 'felt they were not allowed to book an appointment this week'.

He added: 'The capacity is only so great. What do they expect? There are a huge number of practices that do restrict booking.'

GPC negotiator Dr Peter Holden said the advanced access system hailed as the method of hitting the 48-hour target was 'a way of deceiving the public as to the true capacity of general practice'.

PCTs in London, where the department said the problem was worst, admitted a number of practices were restricting advance appointments or stopping them altogether.

Laura Sharpe, chief executive of City and Hackney Teaching PCT, said the trust was working with a 'handful' of practices.

Dr Kambiz Boomla, chair of City and East London LMC, said Tower Hamlets PCT's strategy to meet the target was to refer patients to the local walk-in centre.

The National Primary Care Development Team, which was responsible for rolling out advanced access, insisted it was possible meet the target and offer pre-bookable slots.

Dr Mark Hunt, director of leadership at the NPDT and a GP in Frome, Somerset, said GPs should analyse the percentage of patients who wanted different types of appointments and adjust ratios accordingly.

Never enough slots for patients

Dr Howard Freeman says his south London practice leaves one-third of appointments open for advance booking, but patients still complain there are not enough. 'What the Government wants is for people to have greater access on the day but that is a huge problem for people who want to pre-book. To achieve targets we have to make more appointments on the day.'

He added there were often unfilled on-the-day slots left at the end of a session because the practice had to allow for maximum demand. 'So we end up with on-the-day appointments that people are not asking for,' he said.

'Access benefits people who were unwell and were told the next appointment was in two weeks. We have to be very careful with distorting the need to be seen on the day with the wish to be seen on the day.'

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