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A faulty production line

GP appointment waiting times to be published under new access drive

GP practices are to have their waiting times for appointments published under a drive to improve access, says NHS chief executive Simon Stevens.

Speaking in front of the cross-party House of Commons Public Accounts Committee today, Mr Stevens said that NHS England would begin collecting waiting times data this year.

Mr Stevens added that he wanted to see access to GP appointments improving as a result of the increased investment into the general practice workforce.

At the hearing, that followed a critical report from the National Audit Office that said the Government had a ‘crude’ understanding of current demand and capacity.

 But Mr Stevens said that NHS England was significantly increasing its measurements of general practice, including a scheme for practices to report their workload, and an audit of waiting times.

He told MPs: ‘We want to have more information on the availability of GP appointments for routine conditions, and we are going to start collecting those data through the course of this year.

‘We’re going to publish those so people can see what waiting times are, I think that will be good for patients, it will be good for GPs, actually.’

He added that, while NHS England recognises general practice is under significant strain, it was also receiving investment – particularly in new workforce - and ‘therefore it’s reasonable to expect, on the back of that, improved access’.

Stevens added that this year they would also introduce a ‘GP practice workload tool to measure what is happening inside primary care’.

He told the PAC that the lack of this data on workload pressures had contributed to historic underfunding and was one of the reasons ‘GP services have lost out compared to other parts of the NHS’.

Pulse has asked NHS England to clarify whether waiting times data would be published at individual practice level.

GP leaders said no details had been worked out and it would not be straightforward. GPC deputy chair Dr Richard Vautrey told Pulse: 'Practices operate in varying ways and there are patients who want to wait to see a GP of their choice, how do you qualify that and compare patients who will happily see any GP for a particular episode of care?'

The National Audit Office report highlighted some areas of the country where practices were closing once a week or more during core hours, despite in some cases also receiving funding from the extended access DES.

The panel today clarified that 75% of these practices were located in roughly 50 of the 211 CCGs in England.

NHS England’s director of commissioning development Rosamond Roughton said these patterns were ‘concentrated in very particular parts of the country’ without obvious reason.

She added there was some confusion in practices' response - as follow up queries with some practices revealed many still provide appointment booking, or prescriptions collection services, but that publishing the data had impacted their behaviour.

Ms Roughton said: ‘In many parts of the country [practices] saw the data and were taken aback: "Why are some practices closing for half day when we’re not?”

‘In some ways we know peer pressure is one of the ways we can see change happen.'

She said NHS England would not be afraid to also use contractual penalties to change these behaviours, but intended to take a ‘supportive’ approach initially as many of these practices have acute workforce difficulties.

RCGP chair Professor Helen-Stokes Lampard said that 'data can be a very useful tool in improving patient care' but 'data on waiting times should not be used as a measure of performance, as this will be affected by too many variables'.

'Average waiting times will be influenced by population demographics and deprivation levels in an area, for example, as well as factors at a practice level, such as recruitment difficulties,' she said.

She added: 'The College has not shied away from highlighting the issue of soaring waiting times for patients to see their GP – and we want to work with NHS England and others to improve the service for patients, right across the NHS...

It is essential that any data derived from general practice is used in a meaningful way to inform and improve the health service and the care that patients receive, and is not simply used as a stick to beat hard working GPs and our teams with.

Readers' comments (48)

  • Devil's Advocate | GP Partner/Principal10 Mar 2017 10:37am

    Bot sure if you are inexperienced or naive but demand is limitless over period of time. Many many industries and services has proven this. You don't need to look any further then our social service - once respected and utilized as benefit for those in need, now seen as "right".

    Those who tried Dr First will tell you the same too, as I suspect one of the poster above has tried.

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  • Vinci Ho

    Interesting debate between two 'school of thoughts'.
    Rather , I am more interested in 'decoding' the political dialogues from Ms Roughton and Helen-Stokes Lampard.
    (1) Inevitably, this matter is going to be heavily politicised . Politicians love these waiting time statistics in health services(otherwise , they really do not know anything else to talk about NHS)waiting time for hip replacement, waiting time for outpatient clinic and waiting time in A/E. Now the new 'kid on the block ' is waiting time in general practice, whatever it means is another matter . While we are so tired of politics , politics is even more interested in us.
    (2) The ambition of STP in transferring care out of hospital is beyond realistic and you can read this report Shift the Balance of Care and quotes about STP:
    ‘One of the biggest shifts in how the NHS delivers care for a generation is expected to be completed within five years.
    ‘A further complicating factor is that in-hospital and out-of-hospital care are not on an equal footing when it comes to investment in staffing, infrastructure and the elusive but important issue of prestige.
    ‘And despite the considerable pressures they are facing, hospitals have the infrastructure and payment systems to enable continued investment, while the same cannot be said for care out of hospital. This makes the goal of transferring care out of hospital all the more challenging.’
    So Ms Roughton's point of using contractual penalty to change certain behaviours demonstrated their ambivalence and lack of trust about our performances in primary care.
    (3) While QOF is on its way out (rightly or wrongly), it appears a new complex system of micro-management(particularly on waiting time) is coming. What Helen-Stoke Lampard said about using the data as a stick to beat us is very likely to happen...,,

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  • Vinci Ho

    https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-report-web-final.pdf

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  • I agree with Andrew Fripp (9.3.17).

    Can the RCGP not argue on clinical merit? GPs are presented with a wide range of serious and less serious, urgent and less urgent presentations. Sooner is not always better and is the good GP by definition the one with no waiting list?

    Waiting time for an emergency appointment can be offered if waiting time data is required

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  • Publish all you like, it doesn't help situation on the ground. As I look at our accounts, even if those mythical 5000 entered job market tomorrow, I wouldn't be able to employ them. We are innovative practice who employs ANPs, paramedics and pharmacists. Waiting time to see me is still 4 weeks, no matter how much you try to sell noctors, people want to see doctors. No matter how much we offer, public demands more. Fund us properly, make the job attractive, and maybe people will come and your precious waiting lists may come down.

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  • Devil's Advocate ...there is good evidence your abilities tail off rapidly after 2 to 2 and a half hours of surgery ..... and seeing a kid with a sore throat .... who probably didn't need seeing will just stoke demand...but an upfront fee may moderate some of the demand?

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  • i did regular audits of workload in my previous practice. the computer system isn't good enough to collate the data as data is invalid when the systems crash (as they do) and timings of appointments are often inaccurate. it will give you a gist of what is going on but will never be 100% accurate. The upshot is it will lead to bullying of staff who appear to under perform on the data but when you see what they actually do it may be because they do longer appointments because they have a gynecological, dermatological, minor op or other extra service provided which will not be reflected in the data. all it will do in the end is upset people and then they will leave. Targets demoralize if they are done without reward or thanks and constantly worsen for no extra benefit to the person doing the work. we are all human. You get more from a human by praise and reward in the long term than you do by beaten with an emotionally charged blackmail stick. its time to stop and re think all of this - we are all tired - enough is enough.

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  • Jmd

    There needs to be a careful thought process here.
    We need routine appt data with same day appt system, otherwise the data will be massaged. The computer systems should allow this data to extracted automatically by a central hub. This process is necessary if e are to make a meaningful conclusions and follow up changes and learn in points for best practice.

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