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GPs buried under trusts' workload dump

GP seven-day access programme did not reduce A&E attendance, study finds

Introducing routine evening and weekend GP appointments did not reduce A&E attendance, according to an evaluation of the service.

The report, which assessed the initial impact of rolling out seven-day access in Greater Manchester, found that workforce issues challenged the success of the service, with GPs reporting the scheme ‘diluted’ the GP pool.

Researchers also saw low uptake of appointments across weekends, while the overall proportion of ‘do not attends’ (DNAs) across the week was higher than in core hours.

The report, published by the National Institute for Health Research (NIHR), evaluated the rollout of seven-day access across Greater Manchester in 2016/17, looking at Bolton, Heywood, Middleton and Rochdale (HMR), Oldham, Salford, Stockport, Tameside and Glossop, and Trafford.

It found that, over the analysed period:

  • A&E activity increased in all areas with the exceptions of Bolton (-1%) and HMR (+1%), where activity remained constant.
  • A&E self-referrals for minor ailments rose in most areas, with the exceptions of Bolton (-15%) and HMR (-2%), while Oldham had no change.
  • There was ‘no strong evidence on an impact on hospital admissions’, while no conclusions could be drawn on the impact on GP out-of-hours services.
  • There werre 'several workforce-related challenges' including services being forced to compete for the same limited workforce and the GP pool being diluted due to staff working in both seven-day and out-of-hours services.
  • Uptake of the 50,000 extra appointments increased over the year - with 76% booked - but only 67% were attended.
  • Weekday appointments ‘enjoyed a higher rate of utilisation overall (76-86%) than Saturdays (66%) or Sundays (60%)’.
  • The proportion of DNAs ‘exceeded the typical rate of DNA for core hours’, ranging from 10% to 17%.

These findings reflect a Pulse investigation earlier this year, which revealed that 25% of evening and weekend GP appointments across 80 CCGs are being left empty across England, with particularly low uptake on Sundays.

Greater Manchester LMC chair Dr Amir Hannan said: 'Patients, if they want a better service, they want continuity and they want to be able to see their own GP. What we need to do is continue to invest in practices, so they can support their own patients.

'A lot of patients would not mind getting an appointment in the daytime, if the capacity was there. So, my own feeling is we need to be investing a lot of more in our own practices, because it really does affect continuity.'

BMA GP Committee chair Dr Richard Vautrey echoed these points, and said that while GPs work hard to offer seven-day access, patients are frustrated with lack of access to core hours.

He said: ‘GPs have worked hard to put these services in place, offering more choice for patients to make appointments at times that are convenient for them. While extra appointments may take some pressure off GPs, they are unlikely, as this study suggests, to have a significant impact on A&E attendance.

‘We know from our own patients that their main frustration is being unable to get a timely appointment during normal hours, so we need more investment in the daytime service to address this.’

But NHS England told Pulse that more recent figures show that seven-day access pilots have reduced A&E attendences for minor injuries.

A spokesperson said: 'National evaluation of our more recent GP access pilot areas saw an average 10% reduction in people attending A&E with minor injuries. If a patient needs treatment, it is important they get the right care, at the right place, first time and they now have seven-day access to a GP.'

And Manchester LMC chief executive Dr Tracey Vell said: 'All new services have to be given time to embed for staff and patients which is why in Greater Manchester we are not keen on short contracting models.

'When this was published and information gathered in 2017 we were just starting on journey in some areas. We now have 100% coverage and patients are understanding the service.' 

The impact of seven-day access

NHS England’s evaluation of the first wave of seven-day access pilots found that extending access to routine general practice across seven days had ‘no demonstrable impact’ on either emergency admissions or out-of-hours services, but that minor illness attendance at A&E departments did reduce in 13 of the 20 pilot areas by an average of 14%.

However, a report by two CCGs found ‘no immediate correlation’ between extended hours and the number of people turning up to A&E in the local area.

Two other studies, published earlier this year, found that patients value GP quality over extended access and, respectively, that patients who are less satisfied with their GP opening hours are not more likely to attend A&E departments.

The most recent investigation into seven-day access carried out by Pulse, which was based on an FOI request to all of England's CCgs, revealed that around half a million appointment slots have been left empty on evenings and weekends.

Readers' comments (14)

  • Note that NHS England as usual in complete denial when faced with the facts.
    Surely their days must be numbered. Does anyone have any examples of anytime they got anything right?

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  • Ivan Benett

    The headline is misleading. In fact what the evaluations say is 'NHS England’s evaluation of the first wave of seven-day access pilots found that extending access to routine general practice across seven days had ‘no demonstrable impact’ on either emergency admissions or out-of-hours services, but that minor illness attendance at A&E departments did reduce in 13 of the 20 pilot areas by an average of 14%.' This is a good outcome against a background of rising attendances.
    The extended hours services were never going to impact on admissions, nor designed to, which are of much higher acuity. By the time they present they are far to ill to have been dealt with in an extended hours context. These people need to be seen much earlier in the downward trajectory of their illness, as soon as they start to deteriorate. So they need an early warning system to alert their doctors to their deterioration eg weight gain in heart failure. This is not what the extended hours services are designed for. They are there to manage the same day urgent care demand, yes often for minor illness, that would otherwise go to A&E. Reducing A&E attendances by 1:8 I believe is pretty good. Added benefit is for greater choice especially for people at work.
    The downside is less continuity but for these cases (of same day demand) people usually don't mind. In turn this potentially releases in-hours time for people with long-term conditions (incl. mental health)to see their usual doctor, which is where continuity of care is especially important and makes a great impact.

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  • The spin is strong with you Ivan, but you dealt with none of the more fundamental issues - You propose increasing access instead of keeping demand realistic. You addressed nothing of the greater cost of this service compared to in-hours appts. You presumed that there are plenty of GPs to provide this service with no impact to availability of GPs to do in-hours work. You fail to convince anyone of any significant demonstrable benefit of the greater cost, greater demand placed on GPs, the concomitant state regulation that would be needed, the impact on the economy of greater health spending, I could go on...

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  • GP EH is for minors and has no admissions impact. It however takes limited GP capacity from full MDT clinics and complex case management and puts it in empty clinics that sound good to well people who work (and vote). Top-down diktat for Soundbite politics....

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