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Researchers urge Government to rethink GP access strategy

Patients who are less satisfied with their GP opening hours are not more likely to attend A&E departments, a new study has concluded.

Researchers from Imperial College London looked at GP Patient Survey findings from 8,124 GP practices in 2011/12 and 2013/14 and compared these to annual rates of A&E visits and emergency admissions by their populations according to administrative hospital records.

The study, published yesterday in BMJ Quality & Safety, looked at patient satisfaction with the ease of making an appointment with their GP practice, their opening hours, and patients' overall experience of their practice.

When correlating this to A&E data, they found that only the first measure - the ease of appointment booking - was linked with a slight decrease in A&E visits.

Satisfaction with surgery opening hours and overall patient experience meanwhile seemed to have no impact.

The study concluded: ‘Associations between patient experience of general practice and use of emergency hospital services were small or inconsistent.

‘In England, realistic short-term improvements in patient experience of general practice may only have modest effects on A&E visits and emergency admissions.’

Professor of primary care Professor Azeem Majeed, senior author on the study and a practising GP, said: 'The Government must find alternative ways to handle current pressures on A&E departments.

'For example, we could improve access to GP appointments during normal opening hours, instead of spending scarce NHS resources on extended opening schemes.'

Lead author Dr Thomas Cowling, also from Imperial's School of Public Health, said: 'It makes sense to think that extending GP hours will ease the burden on other NHS services, but our study suggests this might not be the case with A&E.'

It comes as the Government's flagship seven-day GP Access scheme is due to complete with universal access to routine appointments for the whole population of England by next year.

Nine million patients in London were told they could book evening and weekend GP appointments in December, with NHS England stating the measure would #help manage pressures on urgent and emergency care services especially over the busy winter period'.

The evidence for seven-day general practice

This is not the first study to cast doubt on the Government's flagship scheme.

Already back in 2015, NHS England’s official evaluation of the first wave of seven-day GP access pilots made less than convincing reading.

More recently, a CCG-level report saw ’no immediate correlation between GP opening hours and the weighted rates of emergency department attendances’.

At the same time, Pulse revealed last year that seven-day pilots have been set a target of filling at least 60% of appointments, with those falling short asked to submit plans on how they will boost demand.

Another Pulse investigation revealed that many Sunday GP appointments offered as part of the Government’s election manifesto commitments are going unfilled, heaping pressure on standard hours care. In one area, just 2% of appointments were booked up on a Sunday.

But, despite this, as of 2019 all CCGs will receive £6 per patient to roll out evening and weekend appointments across England.

Readers' comments (6)

  • Vinci Ho

    And ,of course , the protagonists of this fairy tale of GP- 7Ds opening (or an even better fiction , 24/7 GPs) would say that the benefits of extended access was never JUST about A/E visits and emergency admissions.
    Well , we all know ‘fairy tale’ always had a heavy price to pay in reality world........

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  • Azeem Majeed

    Vinci Ho | GP Partner/Principal23 Jan 2018 11:46pm

    Thanks Vinci. As always, very insightful.

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  • It's £150+ to get an appointment with the vet in evening and weekend.

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  • Researchers have better do some serious talking to the CCG and LMC goons pushing the agenda at local levels. It's not just the government that's gone off the rocker - it's also the deaf and dumb to reason cardigans pushing colleagues to have a 7 day opening.

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  • 'Nine billion patients in London were told they could book evening and weekend GP appointments in December'
    I'm pretty sure you mean 9 million?
    Most of London has degraded the access by top-slicing the funding for other projects and leaving only a token service in place. This lets the London Region managers tell their NHSE masters the service is up and running, while not providing anything worthwhile either to patients, or any extra capacity to support general practice.

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  • the amount of prebookable appointments available in extended access hubs are pitifully few and won't make a wothwhile dent in the workload for general practice despite taking up a lot of money. They simply double up on OOH and pinch the few GPs prepared to work unsociable hours further damaging OOH. Its so much easier to see 5 prebooked simple cases an hour than trying to cope with chaotic and highly stressful OOH work where most patients have been waiting many hours in distress....I fear we will face a collapse of OOH cover and it will be hastened by extended access.....

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