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Independents' Day

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.


Readers' comments (14)

  • 2020 the year when general pracitice in th uk dies.

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  • Pause no. Scrap yes. I suspect once Hunt gets shuffled off to Transport or somewhere, his successors opening gambit will be "on reflection, this guff about 7 days and 5,000 GPs from the back of the sofa was nonsense, unaffordable nonsense at that"' We'll be allowed a summer of feeling relieved while they "consult the evidence" then get shafted in some other trumped up way. Nuts to the lot of em. 4 yrs, 1 month, 17 days to go.

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  • Vinci Ho

    Not a bad analysis for the government to use as a political stepping-down stone if the whole 7D opening thing is going to fail ,but these blind and arrogant politicians will not listen to you guys in Imperial College.....

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  • Sadly I suspect we are reading what we wish to. The subtext is that poor GP access is a driver to increased A&E attendance, and that should give Jezza plenty with which to beat the bloodied corpse of primary care. Cue Maureen "We welcome this report......".

    Course you do, love. Course you do.

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  • the government conclusion will be that 24 hr 7 day a week GP service will be needed !

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  • Fundamental flaw if they used patient survey data as measure of access. Patient satisfaction with access is subjective and practice population specific. Currently it will reflect satisfaction with Monday-Friday opening on the whole and one would expect practices who see all emergencies to have higher admission rates than those which don't. However, one cannot assume that increasing days from 5-7 will increase patient satisfaction, nor be more effective. As long as there is a well-funded OOH service to which patients know they have access (in the face of politicians and media suggesting otherwise) routine 7 day opening will make no difference at all to admissions (other than detrimetally by taking doctors away from OOH).

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  • I'm still in shock about "there has never been a better time to be a GP". I mean, what on earth was one smoking when this comment was made??

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  • Politicians are driven by ideology, not by evidence or reasoning, so this report will have no effect on them. If their ideology tells them to destroy general practice by overloading and underfunding it so that their rich chums Branson and United Health can take it over, then that is what they will do, taking actions that make life less bad in general practice is against the plan so can be ignored.

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  • Now good access to GP = good access to "my" GP = fewer admissions
    Later increase access to 7d = bad access to "my" GP = more admissions

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  • 7 day access is good for patients.they dont have to wait.

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