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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)

  • 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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