Dr Maureen Baker, RCGP chair
It will come as no surprise to dedicated and hardworking GPs that schemes to extend access have not been as popular as the Government predicted.
It might sounds like a good idea in principle, but our patients realise that this isn’t the best use of precious NHS funds – and they have better things to do on a Sunday afternoon than have their ears syringed.
The Prime Minister’s GP Access Fund has provided welcome funding to some GP practices – but family doctors must be free to tailor these resources to the needs of their local populations, in the best interests of their patients.
Access to GP services is extremely important but prioritising weekend and evening access must not come at the expense of services during normal hours so that patients end up worse off.
We hope that this evaluation will spur the government away from its obsession with a seven-day service and towards ensuring that our existing routine family doctor service and GP out of hours services are more integrated and robust, so that our patients can see a GP when they really need one.
General practice is the bedrock of the health service – we keep our patients out of hospital, where care is more expensive, close to home, where our patients want and need it most.
The RCGP is calling for general practice to receive 11% of the overall NHS budget and for at least 5000 more GPs in England over the course of this Parliament so that we can continue to keep this a reality.
Dr Richard Vautrey, deputy chair of the GPC
It’s only common sense to learn from the evidence of a pilot study, particularly when the NHS has a £30bn funding gap to fill, and this clearly shows that there was little demand from patients for routine GP appointments on a Sunday or even Saturday afternoon in many areas. At £43 per consultation, no reduction in hospital admissions and only minimal changes in A&E minor injury attendances, there must be real question marks about the wisdom of carrying on with these schemes.
When practices are having to cope with as little as £140 per patient for a whole year of comprehensive primary care there is an urgent need to redirect the millions of pounds being spent on this politically motivated project to properly fund both the daily services of GP practices and the under pressure 24/7 GP urgent care service.
Dr Chaand Nagpaul, chair of the GPC
GPs have always been committed to improving patient access and already provide a seven day round the clock service. How we deliver further benefits to the public needs to addressed, but this independent evaluation of the challenge fund pilots raises serious concerns about the value and expense of the government’s inflexible approach to seven day services for general practice.
There was extremely poor demand from patients for appointments on Sundays, and in many cases on Saturday afternoons, resulting in precious NHS resources being wasted on keeping near empty practices open and staffed. The cost of providing care during these hours was significantly higher than routine GP practice appointments during the week. While some areas showed a slight decrease in minor illness attendances at A&E, there was no reduction in hospital admissions, and any cost saving would need to be balanced by the considerable expense of running these pilots.
At a time of extreme pressures on GP services, with many practices struggling to cope with patient demand and falling resources, the government needs to learn the lessons from its own pilots. A number of those areas taking part decided to stop providing weekend sessions owing to lack of demand. Two thirds of the funding for this project was actually spent on worthwhile schemes of benefit to all patients across the week, such as improving digital infrastructure and measures that enhance collaborative working between GP practices.
As the BMA outlined in its recent vision for the future of general practice1, we need to ensure that GP services have the resources to meet the incredible demands being placed on them and not be distracted by headline grabbing initiatives which do not deliver benefits to patients.
Dr Ivan Benett, NHS Central Manchester CCG clinical lead and seven-day access pioneer
The principle of seven-day opening is sound, since its purpose is to mop up same day demand, relieve pressure on in-hours demand so practices can do planned work and provide continuity of care for long-term conditions. It also makes available a primary care service for people who work or have carers who work.
In Greater Manchester we are rolling it out, so that for example, lorry drivers can have diabetic checks, working women can have smears, and the chronically ill can access care before they get too ill.
We have found that the longer the service runs the greater the uptake on Sundays. Besides, we have lots of patient whose Sabbath is on Saturday – Jewish people, Jehovah’s Witnesses and Seventh Day Adventists, so we shouldn’t discriminate against them.
Opening seven days is just the start of making primary care fit for purpose and modern. As well as getting LTCs managed, people will be able to get blood tests, scans, x-rays and other diagnostics so they don’t need to take time off work.
Like the French Revolution, it’s too early to judge the impact of seven-day access.
NHS England spokesperson
This evaluation shows that GPs and their teams are leading the drive for innovation, taking improvements far beyond increasing opening hours. They are providing patients with the right care, from the right professional, at a time which is convenient for them. We will consider the findings of this first evaluation as we take forward our commitment in the Five Year Forward View to strengthen and support primary care.
The report showed some weekend services were well used and some were not. As expected, some approaches were adjusted to match what was shown to be most effective for the local population. Service changes can also take time to bed in, and patients take time to become accustomed to these changes. We will consider the findings as we take forward our plans to strengthen GP services in line with the Five Year Forward View.
Department of Health spokesperson
These results show patients want to see their GP at a time that suits them, with 400,000 evening and weekend appointments in our first ever pilots. This resulted in a 15% reduction in minor A&E visits. By 2020 this approach will be rolled out across the country as part of our plan for a seven day NHS
