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At the heart of general practice since 1960

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GPs watching the Labour leader on Question Time last week must have had a sense of deja vu, writes Ian Cameron

It was one of the few highlights of the election campaign.

Sporting a startled, rabbit-in-the-headlights expression, Tony Blair admitted he was 'absolutely astonished' that GPs were restricting advance appointments in order to meet his government's 48-hour access target.

This was 'absurd', spluttered the Prime Minister, promising to 'look into it'.

GPs watching the BBC's Question Time election debate would have shaken their heads, once they had stopped shouting at the television.

Since the 48-hour access target was introduced in 2000, GPs have consistently argued it is pointless, skews clinical priorities and, most pertinently, that it is impossible to achieve without cutting back somewhere else.

Now, five years on, the Prime Minister seemingly revealed what they must have suspected. He had not been listening.

Yet GPs would also have been surprised because for almost two years Tony Blair's government has been badgering them not to restrict advance appointments.

As early as August 2003 health ministers raised concerns at the 'wilful misinterpretation' of the target by GPs and also PCTs.

The Department of Health later wrote to strategic health authorities asking them to remind PCTs that restricting bookings was 'not acceptable'. The National Primary Care Development Team also produced guidance stating that its Advanced Access system did not advocate restricting bookings.

Last October, Department of Health head of primary care Gary Belfield told an NHS Alliance conference the prime minister was 'interested' in the issue. The following month, GPs were asked for the first time by PCTs whether they restricted bookings beyond 48 hours. One in eight practices said they did.

Now, after a Government-ordered clampdown on GPs, the figure is now 3.6 per cent. Following his TV embarrassment, Tony Blair has demanded it be reduced to zero.

GPC chair Dr Hamish Meldrum believes this will be impossible for as long as the 'crude' access target remains.

'There are not enough GPs,' he says.

'PCTs can clamp down as much as they want but there are only so many hours in the day and there's only so much work GPs can do. If I've got 20 appointments and block off 15 for routine appointments that leaves only five to be booked ahead.'

Dr Ashwin Shah, a GP in Stratford, east London, and access lead at Newham PCT, is one of those whose practice is suffering because of the target.

He has just increased the number of advance appointments as a result of the Government's clampdown. But DNA rates are starting to climb again as a consequence.

'We got DNA rates down from 30 per cent to 2 to 3 per cent,' he says. 'But in the last few weeks we have tried to free up more appointments and it's going back up. Even with more GPs that will still be a challenge.'

Although Mr Blair's gaffe prompted the predictable Government response that GPs will be stopped from restricting appointments, there may also be a surprising and welcome upside.

Health Secretary John Reid has reportedly suggested the access target may be changed, so GPs will be incentivised to give patients an appointment on the day they request.

If this promise survives beyond the election campaign, it would be a staggering U-turn.

The irony of it would also not be lost on Dr Sam Everington, a GP in east London. He says he was forced to move away from exactly that system because it did not accord with 48-hour access targets.

'Everyone was happy but it did not fit the criteria,' he says.

'Now it's far more difficult to offer advance appointments as we are blocking the number of routines.'

Why did Tony Blair

not know about the

problems the 48-

hour access target

was causing when

his Government

clearly did?

August 2003

Ministerial sources tell Pulse the Department of Health is 'increasingly concerned' at GPs restricting appointments

February 2004

Department of Health orders a 'priority review' of the 48-hour access target to report to the Prime Minister in March

April 2004

Department orders PCTs to ensure patients can make appointments 'outside the target times'

August 2004

Department tells strategic health authorities restricting booking 'is not acceptable'

October 2004

Gary Belfield, the department's head of primary care, says the Prime Minister is 'interested' in the issue

November 2004

Department orders PCTs to survey how many practices are restricting bookings each month

February 2005

Health minister Stephen Ladyman tells MPs restricting booking is not consistent with a 'patient-centred' NHS

April 28, 2005

Tony Blair says he is 'astonished' to hear about the problems

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