Government should ‘pause’ GP seven-day access plans, say researchers

Academics have called on the Government to put extended GP opening plans on hold until there is further evidence of the effect on urgent care.

Researchers from Imperial College London analysed 2.3 million emergency admissions from 2011 to 2012, and found a link between access to general practice and the use of A&E departments.

However, they said that the links did not endorse the planned extension of opening hours, concluding that the Government ‘should pause its planned extension of opening hours nationally until a sufficient evidence base has been established’.

The study looked at the number of emergency admissions that were made via a GP referral, and the number of admissions that came through an A&E attendance.

It found that patients of practices where there was good access – measured through the GP Patient Survey – were more likely to be admitted through their practice rather than through an A&E attendance.

It stated: ‘With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17).

‘The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful.’

The study, published in BMJ Quality and Safety, said that these results ‘provide further evidence to suggest that variation in access to general practice is related to usage of emergency hospital services in England’.

However, it added that there needs to be further evidence in favour of the effects of seven-day working, adding the results ‘[do] not fully endorse national policy expectations that practices improving access will affect use of A&E services’.

The writers concluded: ‘No studies have convincingly examined the longitudinal associations between access to primary care and use of unscheduled hospital care, and experimental evidence on interventions designed to improve access is lacking.

‘Our findings should motivate work addressing these gaps in knowledge, particularly that relevant to general practice opening hours. The UK Government should pause its planned extension of opening hours nationally until a sufficient evidence base has been established.’

The Government has pledged seven-day routine access to GP appointments for all by 2020 and same-day appointments for over-75s, but the plans have been widely criticised by GP leaders, who have called for more funding to be put in routine weekday access rather than the ‘pipe dream’ of weekend access.