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Independents' Day

The truth about GP waiting times

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I had the dubious honour of going on national radio last month to talk about waiting times at GP practices.

National newspaper headlines were shouting: ‘Millions waiting longer to see GP’. The Telegraph reported that ‘NHS statistics show that the proportion of people who are unhappy with the opening times of their local practice has risen by one fifth in three years, amid pleas from patients for seven day opening’.

But as I explained into the fat red BBC microphone in front of me, the reality is not that simple.

True, according to the GP Patient Survey, the proportion of patients waiting a week or longer has risen from 15% to 18% in two years. But the survey never asked patients whether they wanted to wait this long. It did, however, ask patients whether they found their appointment convenient and almost all patients (92%) said it was. So far from millions of ‘unhappy’ patients, we’re talking about just 8% who did not get an appointment that was convenient for them.

Neither are the ‘pleas’ for extended GP access quite as desperate as reported. Slightly less than 19% say their GP practice’s opening hours are inconvenient. And of those, when asked what could improve this, 70% wanted to be able to book an appointment after 6:30pm, 73% on Saturday and 42% on Sunday.

So at most, one in eight is ‘pleading’ for some kind of extended access. Hardly a groundswell of patient support for seven-day opening.

But – as I told the programme – the figures do show patients are finding it harder to get through to practices on the telephone and that satisfaction with GP opening hours is slowly declining (75% say they are satisfied, compared with 77% two years ago).

This level of satisfaction is still pretty remarkable given GP funding has fallen by a fifth over the past decade and we’re facing the worst GP shortage in many years. On top of this are changes in population: Pulse revealed last year that some practices were seeing a 25% rise in list sizes, and these are more complex patients who ask to see their GP more often (8.3 times a year, compared with 7.6 in 2010/11). We are simply seeing the symptoms of a mismanaged system coping reasonably well under huge pressure.

In fact, figures from the Nuffield Trust published last year showed general practices have increased the number of appointments they provide by 11% since 2010.

Thankfully, I got most of this across before the radio presenters cut me off. And as I breathed more easily and loosened my collar, I was pleased when a member of the public called in and made a point I’d missed.

She explained, far more eloquently than I could, about what all this means in practice. She had recently moved GP practice after tiring of seeing a different doctor each time she attended, and was happy with the improvement in her care as she saw the same doctor at the new practice.

‘Is this something patients can do?’ a presenter asked me. ‘Yes, if they want to,’ I replied. ‘Although you might have to travel a bit further in more rural areas. But I think this shows a really important point.’

The presenters tried to interrupt, but I kept talking: ‘The continuity of care the caller describes is being destroyed by the Government’s schemes to extend access without adequate resources. Stretching the same GPs across seven – instead of five – days makes it much harder to get that kind of personalised care.’

And perhaps that’s the salient truth here: the current myopic focus on access often completely misses the point.

Nigel Praities is editor of Pulse

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Readers' comments (15)

  • Thank you Nigel for supporting us.

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  • Yep, patients need reminding that they can shop around to get what the service that suits their needs.

    We share a reception desk with the practice that is open 8-8 weekday and Saturday mornings.

    If patients are unhappy that we are only open 8-18:30 and do not do Saturdays, then we advise them that next door can facilitate them.

    Their patient list size is growing, but... so is ours. We have patient coming over from 10-15 miles away because of good routine access and a few specialties that our team has.

    I am, personally, registered with a practice 30 minutes drive away because they have GPs who specialize in sports medicine and now and again I'll book a double appointment to discuss various bits and pieces that I might need advice on.

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  • Vinci Ho

    (1) Take the point some patients have 'different' needs . But then the questions are :what is the majority and minority ? How big and small of them respectively?
    (2) Justice is about maximising welfare(well being),respecting freedom and cultivating virtue/morality. (Michael J Sandel).
    (3) With this current level of resources , we surely cannot provide the 'ideal' welfare or happiness to everybody . The freedom for everybody to book routine GP appointment 12 hours a day , 7 days a week , is only a dream under current circumstances . This freedom , in fact , is head on collision with the virtue of general practice - continuity of care. What is the guarantee that 'referring back to your own GP' is not a prevalent outcome in this new 7 days 12 hours every day system ? Is the moral conviction here is about counting the number of appointments or this virtue of general practice is so fundamental that it rises above this calculation?
    (4) I suppose the only compromise I could imagine is each local region to have its own 'referendum' of which direction to travel. Otherwise, I stick to my argument of all weekend routine appointments should be self funded under current level of funding.

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  • Many patients prefer to wait for the day, time and/or doctor of their choice but those factors aren't taken into consideration when answering the question: how long did you wait for an appointment?

    Given that most surgeries' opening times haven't changed significantly, lower satisfaction ratings suggest a change in expectation (thanks to the 7 day, 8-8, routine opening rhetoric from the Govt) rather than a drop in service level - it's the politicians causing dissatisfaction.

    Thank you for speaking up for continuity of care.

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  • PM above,

    You do not need a GPwSI to tell you that you have a sprain.

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  • Harry Longman

    Agree that 7/7 access will make matters worse. We already have OOH for the small amount of demand which is truly urgent. But when the difficulty is in simply getting access (11% are turned away, RCGP figures) the whole idea that longer hours/more days is better misses the point. Dangerously and wastefully misses the point. We need good access in hours, provided by a stable population of GPs as continuity matters and means more efficient as well as higher quality care. By thinking about these outcomes and thinking differently about how we get there, so much better service is possible now.

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  • Beautifully put. Yet again HMG are manipulating figures to justify their case.

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  • Agree continuity is more important for the majority of patients. This will be reduced by increase in access/hours and will lead to an increase in dissatisfaction not a decrease. A lot of the current alleged dissatisfaction is being stoked up and fed by Government rhetoric and spin, if not downright untruths!

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  • Thanks Nigel for your continual support of GPs.

    There is one and only one reason for the government prioritising access over continuity - votes.

    The vulnerable, mentally ill, deprived populations with multiple co-morbidities and premature mortality do not vote. And these are the patients who really need continuity.

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  • No wonder, if we GPs continue to provide more appointments[ 25% ] for less money [ 25% ] in 10 years, then the Govt would like us to continue in that vein.
    Until and unless GPs define safe working and/or a minimum fee, I can see no reason whatsoever for the DOH not to continue cutting funding for more services.
    Why should they not? They want best value for money.
    If, on the other hand, our esteemed leaders state bottom dollar or draw a line, this fall in pay and increase in work will continue.
    It really is up to us, as Independent Contractors, to pull the rip cord.
    Otherwise, expect more of the same.

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