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The 48-hour access target for GPs should be scrapped and replaced with 'more sophisticated indicators', an RCGP

review paper has concluded.

The RCGP and NHS Alliance commissioned independent research for the paper that found that, on its own, the access target operates 'to the detriment of overall patient care'.

GPs' role in providing care for patients with complex problems could be jeopardised by focusing on 48-hour access, it warned, and could result in excess demand on secondary care.

The paper brought together reports from members of an informal working group comprised of GPs and academics. It reached its conclusions by combining existing research with informed opinion about the effect of the access target on grassroots GPs, taking into account the political context as well.

The document recognised primary care access was the 'number one priority' for the NHS, but said that continuing to focus on 48-hour access conflicted with a 'resource-constrained' system.

It called for a 'substantial evidence base' on which to modify the target, taking into account the location and availability of GPs.

'The 48-hour target is too simplistic for a complex primary care service,' the review paper argued.

'GPs provide personal continuing and generalist care for patients with complex medical, psychological and social problems, and have a central role in the management of chronic disease.

'There is a danger their ability to do this is jeopardised by inadequate time or excessive demand, particularly in providing rapid access for patients with more minor self-limiting problems.'

Instead the paper proposed further research into how best to make use of increasing numbers of part-time GPs. It also called for more use of reception staff, and more patient involvement in service design.

NHS Alliance chair Dr Mike Dixon hailed the study as 'a means of shaping our own destiny'.

RCGP chair Professor David Haslam said: 'Sometimes patients prefer ''my doctor later'' to ''any doctor now''.'

But GPC deputy-chair Dr Laurence Buckman said it wouldn't make any difference as the Government was committed to 48-hour access.

By Ian Cameron

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