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Independents' Day

Seven-day access costs 50% more than routine hours, warn government auditors

The Government has failed to consider the consequences and cost-effectiveness of its controversial drive to offer seven-day routine GP access, its own auditors have warned today. 

The National Audit Office’s Improving patient access to general practice repor t, released today, found that the cost of offering appointments in evenings and at weekends is 50% higher than during routine hours. 

It also warned that the data used by the Government when planning its workforce targets overestimated the number of full-time equivalent GPs in the system by 1,900, meaning that even achieving its recruitment targets will be not enough to provide seven-day access. 

The NAO said drives to boost GP numbers are at risk ‘from falling retention and increases in part-time working’ and added that ministers and NHS England need to address the ‘crude’ understanding of current demand and capacity.

GP leaders said that the report should be the impetus for ministers to ditch plans for seven-day routine GP services. 

Pulse has already reported that that at least £1.5bn will be ploughed into extending GP access by 2021, while NHS England’s own evaluation found that extending access to routine general practice across seven days had ‘no demonstrable impact’ on either emergency admissions or out-of-hours services.

The latest report targets the DH and NHS England for not fully evaluating the schemes. 

The NAO report said: ’The Department and NHS England have not fully considered the consequences and cost-effectiveness of their commitment to extend access.

‘They have used pilots to understand the demand for, and provision of, extended hours, and have used these to refine their expectations. However, they have not yet fully assessed the cost-effectiveness of the approach and overall resources that will be required.’

It added that the costs would be far higher than routine care.

It said: ‘If the additional funding is only used to meet the minimum additional capacity required by the new commitment, this would equate to £230 per appointment hour per 1,000 registered patients. In core contract hours the cost is an estimated £154’

The auditors also found that the Government’s target to recruit 5,000 GPs may not be enough due to ‘inaccuracies’ with its underlying data, highlighting that last year the NHS’s information centre - NHS Digital - overhauled its workforce modelling.

The original modelling had assumed qualified GPs under 35 worked shifts equivalent to 0.9 full-time GPs - eight sessions a week. However, the new model revealed that newly qualified GPs are equivalent to 0.77 of a full-time GP.

The NAO report said: ‘The latest available data on part-time working in new GPs suggest that there may be 1,900 fewer full-time equivalent GPs by 2020 than Health Education England had estimated there would be.’

GPC chair Dr Chaand Nagpaul said: ’Policymakers have underestimated the number of GPs required to deliver their promises by almost 2,000. This comes at a time when the NHS is already suffering from a chronic shortage of GPs with one in three practices having unfilled doctor vacancies.

‘Given that funding in general practice has failed to meet patient demand, NHS England and commissioners need to fully consider the consequences of their plans to extend access. To proceed without any sort of evaluation into the cost-effectiveness or the consequences of its objectives is irresponsible and could lead to much needed investment being spent on measures which don’t adequately meet patient needs.’

An NHS England spokesperson said: ’The NAO seem to be criticising the rather obvious fact that it inevitably costs more to provide evening and weekend urgent primary care services than it does during Monday-Friday, 9-5. The alternative would be that patients simply head to A&E, with all the consequences that brings for more major cases.

‘No one is suggesting each individual GP practice should offer this extended access, but there’s quite wide agreement that - as GP numbers expand - practices do need to club together to offer this service, a bit like the out-of-hours duty chemist rota. Across much of London, Manchester and a fifth of the country GPs are already doing this, and more areas will follow next year. The NAO are wrong to criticise the value for money of general practice, given that the per patient cost of a year of GP care is less than the cost of just two A&E visits.’

Julie Cooper, a Labour shadow health minister, said: ’It is really clear from this report that the Government has little understanding of the scale of the crisis in many of our GP surgeries. Access to GPs has never been worse, satisfaction levels are falling, patient safety is being compromised and morale amongst GPs and their staff is at an all-time low. 

’The Government’s plan to address this crisis is woefully inadequate and all depends on little more than its ability to introduce an additional 5,000 GPs and current recruitment and retention figures make even this unlikely.’

Readers' comments (11)

  • As my one time Dutch partner used to say, "Het is allemaal onzin!" And, you know, that's still true, even today.

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  • Barry, I am guessing that the Dutch translates as 'This is totally mad' - or thereabouts.

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  • Will the BBC report this and interview, no (They don't want to upset him..well let me interview him, I am more than happy to "upset him" with "nasty questions". Boo Hoo.

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  • The problem is that when the pilots have operated in isolation they have been able to attract a pool of GPs from the surrounding regions who are willing to work weekends (for a price). If EVERYWHERE is having to provide 7 day a week access, NOWHERE is going to have a sufficient pool of willing recruits - certainly not to provide traditional OOH cover as well. This will dramatically boost the costs further.

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  • Thank God Ivan retired!
    This sort of report would be the death of him!

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  • What a surprise! Exactly the same is true of hospital 7 day services, as many folk have been trying to tell the government for years... the words "economic" and "illiteracy" come to mind.

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  • Vinci Ho

    Welcome the response of NHSE.
    The more vigorous one defends the indefensible, the more undeniable the truth stands .
    NHSE and DoH love the old argument that the problems in Accident and Emergency departments are entirely caused by GP practices not opening in weekends and hence , no ROUTINE appointments.
    The culture of muddling the public is so prevalent now in this government that even their faithful technocrats(still with a conscience) decided to distance themselves away. Sir Ivan Rogers has become the latest 'hero' walking away from his role of ambassador to EU last week after serving diligently for over 10 years. He clearly knows how to spell the word 'honour' in politics .
    As I said in the past , NAO usually provides fair and independent reflections on the behaviour of the government(s). The response from NHSE is so evidently flawed:
    (1) Continuing to pretend the out of hours GP service non-existing and hence failing to invest in and advertise the service adequately is absurd and despicable. That is where the avoidable attendances to A&E the government(s) constantly referring to all the time , come from.
    (2)Providing routine GP appointments in the weekends is a luxury but certainly not a solution. Patients simply would not go to A/E if they couldn't get a sick note from GPs on Sunday morning. Yes, if the new money is always there , one can argue GP surgeries should be opening even 24/7. That is living in La La land. Of course , you can call an evil because I stand by my opinion that all ROUTINE GP appointments in the weekend should be charged with a fee.
    (3)I was listening to both Barack and Michelle Obama's farewell speeches this morning and could not stop myself from sighing. Sadly , we are facing a reality where politics had lost its meaning in the hands of those with zero conscience and common sense .

    ''I hope you will continue to challenge ill-founded arguments and muddled thinking and that you will never be afraid to speak the truth to those in power.
    "I hope that you will support each other in those difficult moments where you have to deliver messages that are disagreeable to those who need to hear them."
    Sir Ivan Rogers , ex UK ambassador to UN

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  • Council of Despair

    where do we go from here?

    the government are clear - there is no more money, so does that mean the 5YF is unlikely to happen or be funded at all. we know the extra 5000 GPs is unlikely. what i want to know is what do we do next given more cuts are coming and demand is increasing? the only outcome are things are going to get worse - at what point to we declare NHS unsafe? we need some leadership from the GPC and RCGP. I don't think the 5YF will save General practice as the other parts of the NHS are collapsing and the 5YF doesn't take account of that and the subsequent workload.

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  • The NAO are wrong to criticise the value for money of general practice, given that the per patient cost of a year of GP care is less than the cost of just two A&E visits.’

    That's alright then, brag about just HOW underfunded we are compared to any other branch of medicine. It is criminal what we are expected to do for the money they give us per patient per year!

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  • It's actually cheaper than my cat insurance .

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