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The real cost of the 48-hour target

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GP access is rapidly becoming a central battleground for the next election.

While the Conservatives toy with seven-day-a-week surgeries, Labour leader Ed Miliband has resurrected the 48-hour appointment target to end what he called the ‘scandal’ of patients waiting more than a week for an appointment.

Mr Miliband claims that the policy will cost a mere £100m – a sum squeezed from axing competition laws and reducing the number of ‘quangos’ in the NHS (haven’t we heard that before?).

He says that this will improve care and help reduce the pressure on hospitals. And it is – you have to admit - is very clever politics.

The Conservatives left an open goal when they scrapped the target in June 2010 and then stood back as GP practices struggled to cope with rising demand. According to the Labour Party the proportion of people obtaining a GP appointment in 48-hours fell from 80% to just 40% now.

But this is a symptom of a wider malaise in general practice – as highlighted in the BMA’s campaign launched today. £100m is not going to help arrest that. General practice needs a shift change in resources to help it cope with current workload and take on more from hospitals - £1.89 per patient is derisory.

In fact the real cost of the policy will be much harder to calculate.

Any target has the potential to produce unintended consequences. It was widely reported that the introduction of advanced access to meet the 48-hour appointment target resulted in patients finding it difficult to book ahead as practices had to free up time by getting rid of many, if not all, booked appointments to ensure that all patients could be seen within the time limit.

Continuity of care plummeted as practices focussed on meeting the artificial target and patients complained that they struggled to see their usual GP.

Many practices work to this target anyway, but raising patient expectations that they will be seen in 48-hours is irresponsible when many minor ailments could be dealt with by a trip to the pharmacist. If all patients now expect to see a GP in 48 hours then that will place even more pressure on practices.

Mr Miliband may have played a blinder in political terms, but he has got his sums wrong. This target will cost much more than he realises.

Nigel Praities is the editor of Pulse

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