GP seven-day pilot schemes being abandoned in blow to Conservatives' access drive
Exclusive A CCG has cancelled a seven-day GP access pilot after it failed to reduce pressure on local A&E services, while others are considering cancelling theirs, Pulse has learned, casting further doubt on the Conservatives’ flagship scheme to create a seven-day GP service.
NHS Canterbury and Coastal CCG found that its scheme, which saw GPs opening from 9am to 1pm on Saturdays and Sundays from November to April, failed to help local A&Es meet the four-hour target over the period.
Local GP leaders across the country are also reporting that commissioners are considering cancelling other schemes, including one which is costing £70 per appointment.
The Conservatives have pledged to roll out seven-day GP access to all patients across England by 2020, and the Prime Minister’s Challenge Fund has recently allocated £100 million to a second wave of seven-day GP pilots.
The Government has said that this is partly to allow patients to see their GP outside working hours, but it has also claimed it will reduce pressures on A&E.
But GP leaders have said that commissioners’ doubts about the schemes demonstrate that seven-day access is not having the intended effects and was instead wasting NHS resources and worsening the GP workforce crisis.
The NHS Canterbury and Coastal CCG scheme, which was funded via CCG urgent care resilience funds, was aimed to ‘to help reduce pressure on busy A&E departments across East Kent’ as 40% of patients who attend A&E in the area ‘could appropriately be seen by a GP’, according to the CCG.
Dr Gaurav Gupta, a vice chair of Kent LMC whose practice hosted one of the weekend access points, told Pulse the CCG was hoping to prove that it was cost effective to continue beyond the pilot by reducing pressure on urgent care services.
However, a performance report published on the CCG website revealed that in January just 92.5% of patients were seen within four hours in A&E in east Kent, with continued struggles throughout February and March to reach the 95% target.
The report revealed that in total the CCG had spent around £8 million on various schemes to reduce pressures.
Dr Gupta said: ‘The CCG reviewed the pilot at the end of March and concluded it did not make sense to pursue it and so they wanted to scrap it. It continued through April because NHS England wanted it to continue for another month but it has now ended.
‘The CCG was trying to see if it made sense financially, or for patients’ care, so that they would extend it, but they didn’t think that it made sense [and] informed us of their decision.’
He said seven-day services ‘seems more like a political decision, rather than a patient care one’, while the patients mainly accessing the scheme were those ‘coming in to us for routine GP services’, therefore not relieving pressure on A&E.
Dr Mark Jones, chair of NHS Canterbury and Coastal CCG, said: ‘The pilot has been well received by patients in the three towns. Although we are pleased to see some correlation between the uptake of urgent appointments at the weekend and a reduction in A&E attendance, this has not been sufficient to continue with the pilot in its current format.
‘The data collected from the pilot will be important for the CCG, and individual practices, as we develop our intentions for the future design of a seven day service.’
Elsewhere, GPs also reported that weekend opening was not having the intended outcomes.
Dr John Ashcroft, exectuive officer at Derby and Derbyshire LMC, said that a scheme to open practices until 8pm each evening and 8am-8pm at weekends managed to fill 90% of appointments.
However, he added: ‘The number of appointments represents only about 1% of the appointments provided by the practices so isn’t likely to reduce workload perceptively, and hasn’t. But the average cost per appointment has apparently been over £70.’
Dr Kamal Sidhu, a GP in County Durham whose practice is partaking in a CCG-funded Saturday opening pilot, said his local scheme ‘has not been abandoned but the evidence suggests that it actually hasn’t made a difference to A&E attendances’.
Dr Mohammed Jiva, a GP in Middleton and a seven-day opening pioneer, said that the Greater Manchester schemes - which was the basis for Prime Minister David Cameron’s Challenge Fund - demonstrated that the ‘utilisation of appointments fell over the weekend with Sunday coming out the worst’.
GPC deputy chair Dr Richard Vautrey said he was not aware of specific evidence that seven-day pilots were being abandoned but said this could be ‘because very few of the pilots have been properly and independently evaluated’.
He added: ‘However, there is no evidence from the previous misguided implementation of a walk-in centre in every PCT that occurred with the Darzi plan under the last Labour government, that they made any reduction to hospital pressures.
‘Providing routine seven-day services simply expands the service, and if anything could lead to an increase in hospital referrals as more patients are seen. If extra money is available it should be prioritised to invest in current GP urgent care services which would make a big difference to reducing the pressure on A&E.’
Pulse revealed in February that NHS England has extended the funding for the first wave of Challenge Fund pilots after admitting they required a ‘fuller evaluation’.
The Conservative Party was approached for comment.