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Deprivation no excuse for poor access

Dr Zara Aziz's recent article argued for extra funding for inner-city practices because of their particularly difficult caseload, and cited their poor scores in the GP Patient Survey as evidence ('This flawed survey is sucking cash from most-needy practices').

Her argument is, in my opinion, completely illogical. The cause of urban practices performing poorly in the survey is not location, it is the size of the practice, and the behaviour inherent to large practices.

My reasoning is simple: for the cause of poor access to be the high demand caused by the patient demographic, you would expect the number of days it takes a patient to see

a GP to be higher in deprived areas. If patient demand exceeded GP supply by 10 appointments a week, you would have a 40-appointment backlog after four weeks, increasing to a 520-appointment backlog after one year, 1,040 after two years and so on.

This however, does not happen. Access times tend to be constant in all practices, suggesting patient demand and GP supply are equivalent and workload stable. The cause of different levels of access and varying survey results is practice behaviour, and the problem tends to be bigger the larger the practice.

How bad is the problem? Let me explain it this way. Imagine a GP with a patient consulting rate of 180 appointments a week, with 90 of those patients unable to get an appointment for three days.

Workload is constant and matched evenly between supply and demand, and the waiting period of three days persists all year. A combined appointment delay of 270 days is created each week, which is 14,040 each year.

For a practice with 10 partners this equates to a staggering 140,400 days of delay each year. If the waiting time is one week (and there are a few practices with waits this long) then the total annual delay is a staggering 327,600 days, which by my calculation is a little over 897 years.

And for what? To remedy the situation all a GP would have to do is resolve the backlog of 90 appointments. With an extra two slots a day, this would be sorted out forever in just two months. Then this practice's patients would be able to obtain an appointment immediately, with no change in workload and supply equalling demand.

So long as a practice's waiting time doesn't constantly increase, month on month, year after year, then we can be certain the problem with the survey results is a practice behavioural phenomenon, not the product of the types of patient it sees.

From Dr Gary Rogers, Fleggburgh, Norfolk

Access

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