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The waiting game

PM’s Sunday GP opening plans should be ditched, suggests official evaluation

The long-awaited evaluation of the Government’s seven-day GP access pilots has found ‘very low utilisation of Sunday GP appointments’, and concluded resources would be better off used elsewhere.

The study, released today by NHS England, found that the cost of extended hours GP access was between £30 and £50 per appointment offered.

However, many appointments on Sundays and Saturday afternoons were not filled, it said.

It also found that there had been a significant reduction in minor A&E attendances by patients of practices involved in the 20 first wave ‘Challenge Fund’ pilots.

But it found that the potential savings from this reduction was £3.2m a year for commissioners in the pilot area – compared with an overall cost of the scheme of £45m up to March 2015.

The Government has prioritised seven-day GP access as one of its key policies for this parliament, with Prime Minister David Cameron even using his first speech since the election to push the policy.

Pulse has previously reported that there had been little utilisation of Sunday appointments in the pilot areas, and commissioners were looking at dropping them.

The report, carried out by consultantcy firm Mott MacDonald, working with the SQW reseach group on behalf of NHS England, concluded: ‘The vast majority of pilots suggest that utilisation of the extended hours appointments is generally high in the week.

‘There is also evident demand on Saturdays (mornings more so than afternoons) but there is typically very low utilisation of Sunday GP appointments. A number of pilots adjusted staff capacity to better match demand during the course of the programme.’

Other findings included:

  • The typical average cost per total extended hour is in the range of £200 - £280, around 50% of which is the cost of the GP;
  • 90% of patients that responded to the national GP patient survey consider that appointments are at the practices involved are either very or fairly convenient;
  • There was a 15% reduction in minor self-presenting A&E attendances at the pilot practices, compared with a 7% reduction nationally, but there was no discernible change in emergency admissions or out-of-hours services;
  • The average cost per available appointment in extended hours is typically in the range of £30 to £50.

On its weekend utilisation, the report says: ‘This pattern of low demand on Sundays has been evident nationwide.

‘Often these pilots are reporting that low take-up on Sundays and some (although far fewer) also highlighting low demand on Saturday afternoons and evenings.

‘Several pilots have suggested that very low weekend utilisation figures mask success of the weekday non-core slots.’

The report concludes that commissioners should use resources elsewhere.

It says: ‘Given reported low utilisation on Sundays in most locations, additional hours are most likely to be well utilised if provided during the week or on Saturdays (particularly Saturday mornings).

‘Furthermore, where pilots do choose to make some appointment hours available at the weekend, evidence to date suggests that these might best be reserved for urgent care rather than pre-bookable slots.’

The report highlights that there has been benefit in bringing about a culture change in general practice, as well as cutting minor A&E attendances.

It says: ‘The injection of investment into primary care has had a catalytic effect, encouraging practices to move away from operating as independent small businesses and, instead, work collectively’.

Dr Richard Vautrey, deputy chair of the GPC, said that the Government had to take on board the findings of the evaluation.

He said: ‘It’s only common sense to learn from the evidence of a pilot study, particularly when the NHS has a £30bn funding gap to fill, and this clearly shows that there was little demand from patients for routine GP appointments on a Sunday or even Saturday afternoo in many areas.

‘At £43 per consultation, no reduction in hospital admissions and only minimal changes in A&E minor injury attendances, there must be real question marks about the wisdom of carrying on with these schemes.’

He added that practices are having to cope with ‘as little as £140 per patient for a whole year of comprehensive primary care’, and the resources must be ploughed into standard care.

A Department of Health spokesperson said: ’These results show patients want to see their GP at a time that suits them, with 400,000 evening and weekend appointments in our first ever pilots. This resulted in a 15 per cent reduction in minor A&E visits. By 2020 this approach will be rolled out across the country as part of our plan for a seven day NHS.’

Read all the reaction here

Readers' comments (37)

  • Vinci Ho

    The truth is the truth and it cannot be condemned to be a lie and a lie is a lie and cannot be disguised as the truth.
    This just shows how shallow our politicians are .

    ''Truth at last cannot be hidden. Dissimulation is of no avail. Dissimulation is to no purpose before so great a judge. Falsehood puts on a mask. Nothing is hidden under the sun.''
    Leonardo Da Vinci

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  • the question is will this really change the government stance. not a bit. this is the stat that will not be heard coming out of jeremy *unt or David Camerons mouths. There are lies, damned lies and statistics.

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  • I could have told you this for free

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  • Paging a certain North West GP; your prized ideology lies bleeding on the delivery room floor, stabbed through the heart with a stiletto of evidence marked £43 per consult. How does the future look now, I wonder, Dr ? Still wedded to turning us into the medical division of Starbucks? Or might the fact no one, not even punters, wants the service you advocate, bring you down from that high horse you keep riding?

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  • @ 8:37pm

    So true, but they don't ask us/trust us

    Even with delegated co-commissioning it's not much better

    The national agenda must be right not what we know, live, breathe, experience day in day out

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  • A certain GP in Manchester is probably spinning in his grave even though he is not dead.
    Don't get me wrong, I am not against trying new ideas on additional funding but this has been done at cost of existing services at a time NHS is already squeezed and was hailed to be great in Parliament even before it had started.
    Also this GP claimed it would work to reduce admissions.

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  • Come on IVAN let's hear what you think.

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  • Some interesting article from NHS .....

    Imperial transformation programme – lines to take for press officers

    Recent reports have suggested that the Emperor has been seen in public in a state of undress. Nothing could be further from the truth. This advisory, from the Department of Garb, explains how to answer questions from the media about the Emperor’s new clothes.

    Apparel and reality

    “He’s not wearing anything, is he?”

    Line to take: On the advice of new imperial tailor Morforlez and Qipp of Saville Row, the Emperor commissioned a set of splendid robes fashioned from an innovative material which may appear very slightly translucent in a certain light or when viewed from a particular angle.

    The garments are fashioned from purest Nu-Thing ®, selected for its minimal environmental footprint, flame-retardant and dirt-repellent qualities, and durability. As a result, the Emperor’s new clothes are expected to last for as long as the Emperor himself.

    Commitment to transparency

    “Why did he need a new outfit? What was wrong with the clothes he had already?”

    Line to take: As befits a man in his position, the Emperor has to change outfit from time to time to impress fellow heads of state and to avoid embarrassing underspends in the imperial wardrobe budget, which may not be carried from one year to the next.

    None of his existing outfits were fit for purpose and several had been produced by a previous tailoring administration which has since been discredited.

    Furthermore the Emperor is responding to the changing needs of the population, which gets bored easily and demands a constant supply of novelty and spectacle from its leaders.

    Unprecedented return on vestments

    “What did all this cost? How can the expense be justified in an era of public service cuts?”

    Line to take: The government has not disclosed the full cost of the new clothes, which are subject to a complicated formula devised by the Counting House. However, thanks to significant efficiencies elsewhere in the royal household, including a reduction in unnecessary alms, a review of soup kitchens and changes to the system of tithe credits, proposals for the new outfits were fully funded.

    The Emperor is acutely aware of the suffering of many of his subjects during this difficult economic period. He has personally visited several surfs to discuss the issues raised by plague, the failure of the harvest and the ever-present threat of foreign invasion. The need to keep his subjects spirits up is precisely why the Emperor ordered the imperial wardrobe budget to be ring-fenced forever.

    The Emperor has taken a similarly robust line on defence spending, which is why he has doubled the guard on the palace.

    Nothing will come of nothing on

    “Why don’t you just admit that the Emperor is stark-naked and be done with it?”

    Line to take: A leading panel of expert courtiers, handpicked for their cowering and obsequiousness, have confirmed that the Emperor is fully dressed and more splendid than ever. Their findings have been verified by a number of independent bodies who hope to continue receiving the Emperor’s full support and know an uncovered backside when they see one.

    We’re all frocked

    “How will ordinary people benefit from this extravagance?”

    Line to take: Innovations at court ultimately benefit everyone. The Emperor’s advisers are considering how versions of the royal garments could be distributed throughout the realm in due course, with a phased rollout timed to coincide with special anniversaries. If the Emperor has his way, we’ll all be in our birthday suits in time for next winter.

    Fashion editor: Julian Patterson

    Comment on the blog

    @jtweeterson
    julian.patterson@networks.nhs.uk

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  • Took Early Retirement

    Yes, one hopes to hear from Ivan, however....
    Let us not forget the subtext here is that the SOS likes making GPs do penance, as he has publicly said, so this is what it is REALLY about. I bet it will be rolled out nationally, and it will be just shoehorned into the next GP contract, which will be accepted by the GPs with much whinging, but no action to stop it. The BMA will lie down as usual in their role as government doormats.

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  • The real problem is that Super Practice premises can't be left idle for 1 day per week . Infrastructure eats profit. It makes financial sense to have at least some activity to offset these costs and make it attractive to foreign investors . (Kaiser permanent / any large health corp )

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  • TRue enough 8.26 . Not a health need but a profit need.

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  • Ivan Benett

    You guys honestly, especially the anonymous ones. Yes I'm here. But I do have a lfe and don't spend it waiting to respond to you. You'll all be pleased to hear that my daughter had a baby last night, so 7 day access not really on my mind.
    I haven't had chance to digest this report, but it's hardly a surperise to find that when opening hours change there is slow uptake, especially on Sunday.
    Some of you were predicting a flood from 'unrestricted demand' remember.
    The principle of 7 day opening is sound, since it's purpose is to mop up same day demand, relieve pressure on in-hours demand so practices can do planned work and prvide continuity of care for long term conditions. It also makes available a Primary care service for people who work or have carers who work.
    In GM we are rolling it out, so that for example,lorry drivers can have diabetic checks, working women can have smears, and the chronically ill can access care before they get too ill.
    We have found that the longer the service runs the greater the uptake on Sundays. Besides, we have lots of patient whose Sabbath is on Saturday - Jewish people, JWs and 7th day adventists, so we shouldn't discriminate against them.
    Opening 7 days is just the start of making Primary Care fit for purpose and modern. As well as getting LTCs managed, people will be able to get blood tests, scans, x-rays and other diagnostics so they don't need to take time off work.
    Like the French Revolution, it's too early to judge the impact of 7 day access.
    PS for the guy who talked about profit, there's no money in it for me! Just the satisfaction of doing the right thing for our poeple.....

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  • 7.08am Julian - brilliant, got yourself a new follower

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  • It must be awkward for a government-commissioned programme to prove what GPs have been saying for years. We need more capacity, or else patients end up having to get lower quality care from OOH / A&E. And, although growing numbers of patients in our 24 hour society can't get to the surgery during working hours, almost no one wants routine care on a Sunday.

    But surely it's also helpful to have this proven in such an irrefutable way?

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  • Ivan- congratulations on the new addition. Let's remember the important things.

    As far as weekend working- for some it works, for others not. The freedom to choose and resources to implement the most effective opening hours are what we should be pursuing. Our surgery has horrendous on calls on Monday and Friday, usually because people want seeing before or after the weekend when we're not open. Spreading that work out would be appealing, but I don't know how well it would be used.
    If we were funded to find out and adjust our service according to the evidence I think that is just providing a good service. But is it a good use of resources?

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  • As above - Ivan is 1 weekend appointment at £45 better value than 2 for the same price during the week?
    And if this is so valuable to punters why not charge them for this, this bringing in valuable resources to stop the service collapsing?

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  • As someone else has said already, I could have told them that for free... Although, interestingly, I now work in a walk-in centre next to A&E & statistics show that our peak time (OOH & Walk-in combined) is actually late Sunday morning.... so the patients will contact us ad-hoc, just not book appointments, on Sunday?

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  • Sunday opening is a political move, and political moves simply ignore evidence.

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  • "...it's hardly a surprise to find that when opening hours change there is slow uptake, especially on Sunday.." - well, it should be a surprise if all this additional opening was meeting clinical need. Should have been people lining up to catch up with all those health concerns they have prioritised below everything else in life.

    I hope those in favour of this stuff realise that once the demand is created, the funding will be pulled and we'll all have to live with the unrealistic expectations.

    I wonder if the costs to local OOH services (in terms of recruitment, retention and remuneration) were part of the assessment, the necessary OOH emergency service now having to compete for doctors with a more highly funded (£100-140 per hour) routine non-visiting service.

    A small reduction in "minor A&E attendances" - so what? The presenting complaints of those going to a GP instead (attracted by shorter waiting time, presumably) should analysed to discover how many needed to see a doctor at all. Will demand for attention for minor self-limiting conditions rise if access to a doctor becomes easier? (One way of "proving" that the demand is there, I guess).

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  • The DOH quote says it all, really: "These results show patients want to see their GP at a time that suits them, with 400,000 evening and weekend appointments in our first ever pilots. This resulted in a 15 per cent reduction in minor A&E visits. By 2020 this approach will be rolled out across the country as part of our plan for a seven day NHS."

    Patients "want" to see their GP at a time that suits them - but it won't be "their" GP, will it? Do patients (the tax paying ones) also want to pay for the privilege?

    Reduction in minor A&E visits - actually only an 8% reduction more than the national reduction and as above, so what? GPs should not be spending time seeing minor A&E cases.

    "By 2020 this approach will be rolled out" - so no point running pilots and making decisions based on the evidence, then? Just roll it out regardless, both of the benefit (doubtful, minimal and costly) and the resulting damage (to primary care, continuity of care and OOH services).

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  • Ivan, as someone said above, is $45/appt at wkend worth 2 during the week? in an ideal world, everyone inc doctors and patients would be happy, and anyone would get to see a doctor anytime they like. But we're running a big hole in the NHS budget, rather than funding in-hours services and making the job more palatable so retaining more GPs to provide more appts during the week, why on earth are we paying more per appt to see people at the wkend for (as the study shows), reduction in minor A&E attendances and none in everything else. Surely, minor A&E attendances should be told where to go, wkday or wkends. My assessment of your comments, and the government's likely stance or lack of change of position, is summed up in 1 word - BLINKERED

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  • I'm assuming this means Sunday afternoon appointments will form a central plank of Jeremy Hunts push for 7 day access ..in the light of this evidence he will see it as 'vital' to the whole 'send 'em all to Auz' GP whipping adgenda

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  • ..so nice to have Ivan on here again, by the way, Ivan Bennet...sing it loud, sing it proud, that's his name ...don't wear it out

    Anonymous :)

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  • Have moved to Australia in order to avoid current bunfight but reality is that working people need to see doctors at weekends for minor problems. If we belittle this fact we belittle our own roles. Now regularly work weekend shifts over here but the difference is that still don't work much more than 36 hrs a week.
    The problem comes with fitting in weekend work on top of 50 hour working week which is not palatable.

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  • working people need to see doctors at weekends for minor problems.

    - what nonsense. ignores the rights that working peoples have to access healthcare during work times, plus employers obligations to fulfill them. and also that not all minor problems need to see a doctor. This is all part of the consumerist culture and undervaluing of frontline healthcare workers. Now if you put a charge on these weekend appts that working people have to pay, I suspect the demand will disappear magically

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  • Took Early Retirement

    Congratulations Ivan! May you have much joy in the little one.

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  • Congratulations Ivan my old mate!

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  • Congratulations Ivan my old mate!

    Wonderful news. I'm sure you'll be pleased to know that since leaving old blighty I have had a new addition too who is just 2 months

    It's amazing what can be achieved when one has the time and the inclination to get ones leg over!

    Now I am sure this may not have happened for me had Sunday not been a funday.

    Congratulations again on your beautiful new addition!!

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  • Ivan, not attacking you, just quoting you. Are you really saying that this is justified so a woman doesn't have to take 1 hour off work for a smear test every 3 years? 1 hour in 3 years?

    or an HGV driver take 1 hour off every what 5 years for his medical?

    also please tell me how the NHS discriminates against those who hold sabbath on different days? does the jewish faith really say they cannot seek healthcare on a sabbath? if it does...well there's always the OOH service on another day no?

    you, like many politicians and idealistic GPs in the upper echelon's of schmoozeville (GPC, RCGP et al) seem to disregard the fact that a vast majority of the work we see is coughs and colds which never even need to cross the threshold in to the surgery, let alone be seen on a sunday.

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  • Yes am sure that if you were running your practice anon 354 you would understand that employers of small businesses struggle with accomadating time off for smears and BP checks. The culture is consumerist- we need to get over it and get on with it.

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  • Congratulations Ivan, I hope all is well worth your grand child.

    I'm afraid your comments says it all
    -slow up take on Sunday's increasing. How do you know this is due to existing demand being serviced as patients realise the new opening hours (but if that's the case, is the failure of your comms?) Or increased access creating increased demand as we know this normally happens in all free service.
    -reduction in aed attendance. Again, is this continuing to fall in proportion as Sunday uptake increases? If not, the reduction would have nothing to do with Sunday opening
    -track drivers health checks and routine smear. Surely this would make no difference to aed attendance therefore where is the cost saving? Are you expecting the tax payers to cough up twice as much per consultations for small number of peoples convenience? I'd this a good use of the budget when DoH wants to cut it by 22 billion?

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  • I would even more like to ditch our stupid lying and callous PM and his foul henchmen

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  • "The culture is consumerist- we need to get over it and get on with it."

    Actually, no we don't I'd rather retain some self respect and not devalue my professional role.

    I do run a small practice and have no problem allowing staff time off for medical appointments that cannot be arranged out of working time; it would not have occurred to me to do otherwise.

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  • Anonymous: you need to sign up to NHSnetworks and you will get Julian's blog every week. I am a scientist and not so clever with words. It brings me joy to read how well he expresses my thoughts!

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  • Ivan, an HGV medical exam isn't even an NHS service. Why would we be squandering precious NHS resource on providing this on a Sunday ? If this is a central part of your argument then your case is as weak as the threads holding the emperor's costume together This made me angry until realised that you don't have to justify this nonsense to me but only to the membership of your CCG. Hmm.
    Incidentally, who would get the HGV fee?

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  • Ivan Benett

    'Ben Wyatt | GP Partner01 Nov 2015 9:59am - Ivan, an HGV medical exam isn't even an NHS service.'
    Hi Ben, I wasn't talking about HGV examinations, but an example of someone like an HGV driver who needed a diabetic check. Nothing to do with HGV licence. I think it's clear enough if you read what I said.
    Perhaps I can persuade you that some people find it difficult to get time off work to attend for essential medical checks for their long term conditions, and perhaps opening beyond normal opening hours would allow this. I can see you'll be hard to convince.
    Still at least you've named yourself!
    Anonymous | GP Partner31 Oct 2015 8:42am - well the NHS is supposed to be a universal health service, free at the point of use. If you'd prefer it not to be then you have a right to say so, and make the case to the public, but at least be brave enough to say who you are. Or email me so I can have an exchange of views - no one has yet! ivan.benett@nhs.net

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  • As a patient why should I go to my GP on a Sunday which is "my time" when I can go during the week which is is "my boss's time".
    As ever, no one looks at the system through the eyes of the customer

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