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At the heart of general practice since 1960

Debate: Will the 48-hour appointment target improve care for patients?

Labour’s proposals for a new GP target are unrealistic, argues Dr Chaand Nagpaul, but GPs can’t call for resources without reforms, Sir John Oldham responds

Sir John Oldham leaning square


Most public surveys I have seen recently on the NHS have placed access to GP surgeries as the biggest problem the organisation faces – just last week I saw the results of one survey from across the whole of Lincolnshire that said as much.

MPs and others hear the same as they go round, and so it is inevitable that politicians will respond – indeed, it is their job to represent the views of their constituents.

It is a fact that we have not only failed to maintain prompt access to GPs, but that standards have actually slipped. This is partly due to changes in demand, but it is also partly due to GPs lapsing into old methods of managing it.

I even know of a few surgeries that have ceased to provide any weekend service, and yet the partners still work four or four and a half days a week as though they still did. When many in the rest of society are taking pay cuts, that behaviour doesn’t sit well. Therefore, raising access as a major NHS issue is perfectly legitimate.

Furthermore, the Labour proposal is more nuanced than just reinstating the 48-hour target.

My understanding is that it recommends GPs offer patients consultation by any means within 24 hours. If the patient needs it, then GPs should endeavour to book them an appointment with a GP or nurse within 48 hours. Patients should also be able to book ahead to see the GP of their choice, whenever that may be.

Labour also indicates there would be incentives available to help GPs fulfil these recommendations in doing that.

Meeting these targets is doable, provided practices embrace the digital revolution as a means of managing demand, which they should anyhow.

However, simply calling for more resources without reform is not realistic in the age we live in.

Professor Sir John Oldham is a former GP from Glossop, Derbyshire, who has led a review on health policies for Labour.


Dr Chaand Nagpaul


All GPs would like their practices to offer good routine access for patients but exponential rises in patient demand has far outstripped capacity in general practice.

Despite this, practices rightly continue to offer clinically urgent appointments on a same day basis if necessary, which means that routine appointment waits have, necessarily, increased to over one week in some practices.

GPs are working harder than ever before and can give no more. According to a recent BMA survey, almost all GPs reported working beyond their contracted hours regularly, while six out of ten GPs were considering retiring early.

Introducing a new 48-hour target will do nothing to address these underlining, crippling problems. It risks distorting clinical priorities as practices will be incentivised create systems to achieve targets, rather than the clinical needs of their patients.

Neither do they promote self care, to ensure that GP services are used appropriately. Rather than managing public expectation on a service that is overstretched, these access targets will stoke demand which cannot be met.

The proposed investment of £100 million is less than 0.1 per cent of the NHS budget, and equates to a mere £2 per patient. This simply fails to grasp the true funding gap in general practice.

GPs are not against change, and are willing to work differently and embrace new technologies where appropriate, but they are dismayed and frustrated at not being able to provide patients with the care they need.

This is why the BMA has just launched the new ‘Your GP cares’ campaign which tackles head on the underlining problems facing GP services, and reasons for delays in getting a GP appointment.

We need long term, sustainable investment in GP practices, their staff and their premises, so that we truly develop a service fit for the demands of the 21st century.  Anything short of this will be offering the public a false solution that will do nothing to improve their care.

Dr Chaand Nagpaul is the chair of the GPC and a GP in north west London.

Readers' comments (15)

  • Professor Sir John Oldham

    - where is the evidence that 'embracing the digital revolution' actually manages the sort of demand that will arise?

    - technology can help in some cases but personal anecdotal evidence is the very patients that create the demand don't make use of technology. In addition the technology is a demand i.e. training, implementation, follow up etc. I'm not saying it's no help but it's like using a cork to plug the hole in the titanic.

    - 'If the patient needs it' - we have patients who will happily sit in surgery all day every day (narcissistic, emotionally unstable personality disorder, VTB etc). Are you saying that we need to cater to 'wants' as opposed to clinical need? If this is the case I will throw my VTS notes in the bin and whatever my patient's want I will do. Want a referral 'cos you feel like it - no problem I will do it because Prof Oldham
    says if you want it we should do it.

    - 'However, simply calling for more resources without reform is not realistic in the age we live in.' Have you examined what sort of resources will be needed i.e. costed it? No, didn't think so.

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  • I spoke to Andy Burnham's office a couple of days after the announcement. The admitted that they didn't know how 48 could be enforced as a right, and that the money they were offering, which they claimed would fund an additional 3million appointments, was far short of the 40 million extra appointments we need.
    Patient's with urgent concerns need quick access to expert advice, and every practice should offer this, with the possibility for face to face assessment according to clinical need. In my practice, for the last few years every patient thinks their problem cannot wait for a routine appointment is called back by a GP within 10-60 minutes. About 60-70% of concerns can be dealt with over the phone and the rest are either seen on the day or booked with their usual doctor at the next available appointment.
    48hrs appeals to busy working people (voters), but it is a political target lacking any clinical relevance. As I pointed out to Labour last week, it has alienated GPs but more importantly it will not help patients.

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  • Of course patients might benefit from a guaranteed appointment in 48 hours, but we also need GP's capable of dealing with the load.

    However you look at it, there are only so many hours in a day and so many slots you can fill and most importantly, who wants to be seen by a GP that is so exhausted his mind cannot be on his job?
    Each GP practice should have the number on their books restricted according to the whole time equivalent GP's they have to deal with patients.
    GPs get penalised for closing their books simply because they cannot safely manage the numbers then get penalised fro not being able to provide appointments when day still only has 24 hours in in it.

    GP's cannot win, the government promised patients a 'star spangled service' without the resources to provide it ... but of course that too is the GP's fault.

    How nice it would be to get back to the days when GP's actually had time to care fro patients, where a GP was a 'family doctor' that made the time to know and care for his patients.
    My GP is one of the best and when I am unwell, he is concerned fro my wellbeing, but I am just as concerned fro his, he is tired, exhausted, frustrated that he cannot do the tho job he trained to do ..,.care for the sick!

    Time we stopped the 'GP bashing' campaign and allowed GP's to do what they do best ... care for the sick!

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  • Politicians must reform too and stop using GPs as the whipping boys of this failing health service.

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  • A consultation by digital means still constitutes a consultation . There is the disadvantage of not being able to examine the patient , Time taken may be the same . Since time is the limiting resource Prof Oldbum is mistaken if he thinks embracing technology will improve access,

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  • I am concerned regarding the "right" to book ahead with the doctor of your choice - sounds great but every practice has at least one "popular" doctor [for whatever reason] and appointments for these doctors go fast. There are only so many hours in the day and when appointments are booked they are not available to others - no matter what "rights" a politician has bestowed. A recipe for conflict and stress for reception staff and doctors - as well as a guaranteed fail for whichever political party is unwise enough to promise it.

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  • There is no answer!!

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  • We used to be paid £ 80 per patient in real terms 9 years ago for an average 4 consults per year. We are now paid £ 60.00 for 6 consults. That is a 50% pay cut in 9 years.
    i.e. we work more for less, so each item has halved in value. To expect ever more when take home pay per consultation is £ 3.00 [ after Tax, NIC and paper work] is not going to help recruitment.
    The view that our work loads are lost in average list sizes is not generally held, but mathematically true.
    As the population ages the work loads will increase.
    How can we demonstrate that this workload is so huge that hardly any one wishes to stay by choice and would leave this profession as soon as they can.

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  • Drachula

    What irritates me about Sir John's article is that the world of GPing is very different from 20 years ago, and the comparisons of days or hours worked are not valid. We do longer surgeries, see more people, do more paperwork.
    I agree that we don't do the number of hours that GPs used to, but we would do 60 hours in 5 days and then we have to attend mandatory meetings and stay up to date, proving it for appraisal purposes. We are under far more scrutiny than 20 years ago and must follow many, sometimes conflicting, guidelines and protocols.
    I think that 40 or 50 hours over 4 days is reasonable and gives time for tge hidden hours. The alternative is to spread the time over 5 days and work 9-6.
    So, who does extended hours?

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  • Bullsh*t from a former GP makes me want to become a former GP.

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