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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)

  • 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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  • "'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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