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Independents' Day

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)

  • 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 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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  • 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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